Provider Demographics
NPI:1831588508
Name:MELNIKOV, MAKSIM
Entity type:Individual
Prefix:
First Name:MAKSIM
Middle Name:
Last Name:MELNIKOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8451 LANDER ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2020
Mailing Address - Country:US
Mailing Address - Phone:718-708-9837
Mailing Address - Fax:
Practice Address - Street 1:8451 LANDER ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-2020
Practice Address - Country:US
Practice Address - Phone:718-708-9837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315466-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse