Melvin Leo Wiedman, MEDICAL DOCTOR

Primary specialty

SpecialistTaxonomy code 174400000X

License

B02406 Issued in NY

Practice address

2110 Northern Blvd
Ste. 205
Manhasset, NY 11030-3502

Phone

(516) 627-1811

Fax

(516) 627-1315

NPI assigned

Jun 29, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prohealth Care Associates LLP

  • Internal Medicine Physician
  • Lake Success, NY
  • NPI 1275596280
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235167206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 NORTHERN BLVD",
            "address_2": "STE. 205",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303502",
            "telephone_number": "516-627-1811",
            "fax_number": "516-627-1315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 NORTHERN BLVD",
            "address_2": "STE. 205",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303502",
            "telephone_number": "516-627-1811",
            "fax_number": "516-627-1315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDMAN",
        "first_name": "MELVIN",
        "middle_name": "LEO",
        "name_prefix": "Dr.",
        "credential": "MEDICAL DOCTOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "B02406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Gerald White, M.D.
• Blair M Whitley, NP
• Matthew James Whitson, MD
• Jill S Whyte, MD
• Jordan Field Wicker, M.D.
• Mohammad Masum Wiese, MD
• Ashley Ann Wilk
• William F Shea II DDS PC
• Lisa Williams-Busillo, M.D.
• Regina Williams, P.A.

• Specialist in Manhasset, NY
• Providers in Manhasset, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.