Provider Demographics
NPI:1366097388
Name:BORIS MELNIKAU MEDICAL PC
Entity type:Organization
Organization Name:BORIS MELNIKAU MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MELNIKAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-306-7820
Mailing Address - Street 1:319 HARDENBURGH AVE
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-1306
Mailing Address - Country:US
Mailing Address - Phone:917-306-7820
Mailing Address - Fax:
Practice Address - Street 1:311 N MIDLAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1638
Practice Address - Country:US
Practice Address - Phone:917-306-7820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty