Provider Demographics
NPI:1174887160
Name:REID, MELONIE HOPE (LAC)
Entity type:Individual
Prefix:MISS
First Name:MELONIE
Middle Name:HOPE
Last Name:REID
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1496
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10159
Mailing Address - Country:US
Mailing Address - Phone:917-539-5436
Mailing Address - Fax:
Practice Address - Street 1:248 E 73RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4303
Practice Address - Country:US
Practice Address - Phone:917-539-5436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004802171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist