MEDICARE: MELISSA HUBERTUS

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1538936216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA HUBERTUS

Provider Business Mailing Address
First Line	:	136 HARRISON AVE FL 5
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02111-1800
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	136 HARRISON AVE FL 5
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02111-1800
Country	:	US
Telephone Number	:	845-661-0161
Fax Number	:

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

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

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Directions to “ MELISSA HUBERTUS ” Practice Location

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