MEDICARE: EILEEN GAIL MELTZER R.N. B.S.

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	363LW0102X	Women's Health Nurse Practitioner	420093-1	NY

General Provider Information

NPI Number	:	1730265810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN GAIL MELTZER R.N. B.S.

Provider Business Mailing Address
First Line	:	15 FISCHER AVE
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-8505
Country	:	US
Telephone Number	:	845-658-8108
Fax Number	:

Provider Business Practice Location Address
First Line	:	169 WASHINGTON AVE
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-4855
Country	:	US
Telephone Number	:	845-338-0840
Fax Number	:

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/08/2007

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