Provider Demographics
NPI:1902445620
Name:IRINA L MELNIK, MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:IRINA L MELNIK, MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MELNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-491-1210
Mailing Address - Street 1:9 EQUESTRIAN CT
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-2600
Mailing Address - Country:US
Mailing Address - Phone:415-491-1210
Mailing Address - Fax:415-491-4647
Practice Address - Street 1:655 REDWOOD HWY FRONTAGE RD STE 203
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3025
Practice Address - Country:US
Practice Address - Phone:415-388-3808
Practice Address - Fax:415-388-3089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty