Provider Demographics
NPI:1770122426
Name:MELI- PRUZHANSKY, PATRICIA A
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:A
Last Name:MELI- PRUZHANSKY
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 1:49 DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4021
Mailing Address - Country:US
Mailing Address - Phone:631-745-7124
Mailing Address - Fax:
Practice Address - Street 1:49 DAWSON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-4021
Practice Address - Country:US
Practice Address - Phone:631-745-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-29
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist