Port Jefferson Medical Wellness PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PORT JEFFERSON MEDICAL WELLNESS PLLC

Practice address

595 Route 25a Ste B
Miller Place, NY 11764-2646

Phone

(631) 849-1586

NPI assigned

Mar 16, 2021

Organization subpart

No

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

Authorized official

Name

Mariann Melicharek, MD

Title

Owner

Phone

(516) 286-4441

Specialties & licenses 1

Addresses

Other names 1

• Messi Medical Wellness Doing business as

Locations

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

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615852800000",
    "number": "1649855099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 S OCEAN AVE",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117723702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 ROUTE 25A STE B",
            "city": "MILLER PLACE",
            "state": "NY",
            "postal_code": "117642646",
            "telephone_number": "631-849-1586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT JEFFERSON MEDICAL WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-16",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A",
        "authorized_official_last_name": "MELICHAREK",
        "authorized_official_first_name": "MARIANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-286-4441",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Messi Medical Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Platinum Family Medicine P.C.
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• Yama Qaderi, P.A

• Clinic/Center in Miller Place, NY
• Providers in Miller Place, NY by specialty
• Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; 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.