Provider Demographics
NPI:1962374199
Name:MELITZ MEDICINE PC
Entity type:Organization
Organization Name:MELITZ MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AFSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHKOOHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-450-0969
Mailing Address - Street 1:8 FAIRFIELD RD # A
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1436
Mailing Address - Country:US
Mailing Address - Phone:646-450-0969
Mailing Address - Fax:949-703-7557
Practice Address - Street 1:2 MELITZ STREET
Practice Address - Street 2:N/A
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950
Practice Address - Country:US
Practice Address - Phone:646-450-0969
Practice Address - Fax:949-703-7557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty