Provider Demographics
NPI:1730625484
Name:KASTEN, MELISSA LAUREN
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LAUREN
Last Name:KASTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7219 LITTLE NECK PKWY
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1128
Mailing Address - Country:US
Mailing Address - Phone:917-968-1924
Mailing Address - Fax:
Practice Address - Street 1:7219 LITTLE NECK PKWY
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1128
Practice Address - Country:US
Practice Address - Phone:917-968-1924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1099690172174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist