MEDICARE: MELISSA A. DOFT MD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	050794	CT
2	261QM2500X	Medical Specialty Clinic/Center	2394161	NY

General Provider Information

NPI Number	:	1427302397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELISSA A. DOFT MD PLLC

Provider Business Mailing Address
First Line	:	655 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-5937
Country	:	US
Telephone Number	:	212-600-4109
Fax Number	:	917-591-9090

Provider Business Practice Location Address
First Line	:	655 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-5937
Country	:	US
Telephone Number	:	212-600-4109
Fax Number	:	917-591-9090

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MELISSA ANN DOFT
Credential	:	MD
Telephone Number	:	212-600-4109

Provider Enumeration Date	:	10/31/2012
Last Update Date	:	10/31/2012

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