Doctor Name: | DR. PHILIP MELNEKOFF |
NPI Number: | 1013129519 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 004072 |
Business Practice Address: | 108 Terryville Road Port Jefferson Station, NY - 117760248 |
Business Phone Number: | 6319282349 |
Business Fax Number: | 6314737830 |
Mailing Address: | 18 Fairway Drive, PORT JEFFERSON |
State: | NY |
Postal Code: | 11777 |
Phone Number: | 6314737830 |
Fax Number: | 6314737830 |
NPI Enumeration Date: | 05/04/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 004072 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |