Guardson Cloma Mellijor

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

040188 Issued in NY

Practice address

111 Wadsworth Ave
New York, NY 10033-6102

Phone

(212) 740-7400

Fax

(212) 740-7408

NPI assigned

Dec 10, 2019

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

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

TLC Clove Lake Physical Therapy PCGroup PAC ID 6406934389, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

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.

• TLC Clove Lake Physical Therapy PC

  • Physical Therapist
  • Staten Island, NY
  • NPI 1659549715
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1575936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575936000000",
    "number": "1578100475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 ZABRISKIE ST",
            "address_2": "2ND FLOOR",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "07307",
            "telephone_number": "929-378-0642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 WADSWORTH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100336102",
            "telephone_number": "212-740-7400",
            "fax_number": "212-740-7408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLIJOR",
        "first_name": "GUARDSON",
        "middle_name": "CLOMA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-10",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "040188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Uri Meller, M.D.
• Renae Mellerski
• Erin Kathleen Melley, PA-C
• George Slade Mellgard, MD
• Joseph Anthony Mellia, MD
• Kristen M Mellin, PA-C
• Mark V. Mellinger, PHD
• Ingo K. Mellinghoff, M.D.
• Claude Ann Mellins, PHD
• Ian Alexander Mellis, MD, PHD

• Physical Therapist in New York, NY
• Providers in New York, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.