Melanie Gay Forman, ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

F304843-1 Issued in NY

Practice address

558 Arlington PL
Cedarhurst, NY 11516-1006

Phone

(516) 444-9940

NPI assigned

Oct 8, 2012

Last updated

Jan 6, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Brookview Medical Associates, PLLC

  • General Practice Physician
  • Bohemia, NY
  • NPI 1871965855
  Medicare reassignment NPD
• MGF Wellness Visits LLC

  • Adult Health Nurse Practitioner
  • Atlantic Beach, NY
  • NPI 1720453046
  NPD (past) Authorized official

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

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452038400000",
    "number": "1578815015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1618 PARK ST",
            "city": "ATLANTIC BEACH",
            "state": "NY",
            "postal_code": "115091520",
            "telephone_number": "516-451-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "558 ARLINGTON PL",
            "city": "CEDARHURST",
            "state": "NY",
            "postal_code": "115161006",
            "telephone_number": "516-444-9940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "MELANIE",
        "middle_name": "GAY",
        "credential": "ANP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-08",
        "last_updated": "2016-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F304843-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Five Towns Heart Imaging Medical, PC
• Five Towns Imaging Medical PC
• Five Towns Medicine, P.C. (Five Towns Medicine and Cardiology)
• Five Towns Medicine, PC
• Five Towns RX Inc
• Shira Forman, OTR/L
• Howard Fredrick Foster, LCSW
• Eric L Freeman, MD
• Abraham Moshe Freud, M.ED
• Robert M Fried

• Adult Health Nurse Practitioner in Cedarhurst, NY
• Providers in Cedarhurst, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.