MEDICARE: KIM M MELENDEZ

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	104100000X	Social Worker	098369	NY

General Provider Information

NPI Number	:	1962055483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM M MELENDEZ

Provider Business Mailing Address
First Line	:	12360 83RD AVE APT PHC
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-3452
Country	:	US
Telephone Number	:	917-723-4651
Fax Number	:

Provider Business Practice Location Address
First Line	:	11655 QUEENS BLVD STE 216
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6527
Country	:	US
Telephone Number	:	917-723-4651
Fax Number	:

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

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	07/23/2019

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Directions to “ KIM M MELENDEZ ” Practice Location

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