MEDICARE: MELINA CHERIAN POOPPALLIL DDS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	61891	NY

General Provider Information

NPI Number	:	1518588920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINA CHERIAN POOPPALLIL DDS

Provider Business Mailing Address
First Line	:	13 RED OAK LN
Second Line	:
City	:	CORTLANDT MANOR
State	:	NY
Zip	:	10567-6136
Country	:	US
Telephone Number	:	914-552-6356
Fax Number	:

Provider Business Practice Location Address
First Line	:	381 S LITTLE TOR RD
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-1427
Country	:	US
Telephone Number	:	845-634-5208
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2020
Last Update Date	:	12/22/2021

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