MEDICARE: MELITZ MEDICINE PC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1962374199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELITZ MEDICINE PC

Provider Business Mailing Address
First Line	:	8 FAIRFIELD RD # A
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1436
Country	:	US
Telephone Number	:	845-237-4475
Fax Number	:	845-237-4494

Provider Business Practice Location Address
First Line	:	2 MELITZ STREET
Second Line	:	N/A
City	:	MONROE
State	:	NY
Zip	:	10950
Country	:	US
Telephone Number	:	646-450-0969
Fax Number	:	949-703-7557

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AFSHIN SHAHKOOHI
Credential	:	MD
Telephone Number	:	646-450-0969

Provider Enumeration Date	:	09/18/2025
Last Update Date	:	03/12/2026

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