MEDICARE: DR. MELISSA RANDY GITMAN M.D.

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	207ZM0300X	Medical Microbiology Physician	290598	NY

General Provider Information

NPI Number	:	1528276649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA RANDY GITMAN M.D.

Provider Business Mailing Address
First Line	:	1425 MADISON AVE RM L9-52
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6514
Country	:	US
Telephone Number	:	212-659-8173
Fax Number	:	212-427-3082

Provider Business Practice Location Address
First Line	:	1425 MADISON AVE RM L9-52
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6514
Country	:	US
Telephone Number	:	212-659-8173
Fax Number	:	212-427-3082

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	03/01/2018

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