NPIMap

Organization Active NPI

Melville SC, LLC

  • Multi-Specialty Clinic/Center
  • Melville, NY
National Provider Identifier
1679903470
Registry record updated Nov 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
5153209R Issued in NY
Legal business name
MELVILLE SC, LLC
Doing business as
Melville SC Anesthesia
Practice address
1895 Walt Whitman Rd
Suite 10
Melville, NY 11747-3031
Phone
(631) 293-9700
Fax
(631) 293-2021
NPI assigned
Nov 15, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2013

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

Authorized official

Name
Prof. Daniel Forsberg, PA-CNPI 1770672701
Title
Executive Director
Phone
(631) 293-9700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X 5153209R NY Primary

Addresses

Primary practice location

1895 Walt Whitman Rd
Suite 10
Melville, NY 11747-3031

Mailing address

1895 Walt Whitman Rd
Suite 10
Melville, NY 11747-3031
Phone (631) 293-9700

Other identifiers 2

IdentifierTypeStateIssuer
33D0654179OtherNYCLIA
01287085MedicaidNY

Other names 1

  • Melville SC Anesthesia Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1384473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384473600000",
    "number": "1679903470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1895 WALT WHITMAN RD",
            "address_2": "SUITE 10",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117473031",
            "telephone_number": "631-293-9700",
            "fax_number": "631-293-2021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1895 WALT WHITMAN RD",
            "address_2": "SUITE 10",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117473031",
            "telephone_number": "631-293-9700",
            "fax_number": "631-293-2021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELVILLE SC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-15",
        "last_updated": "2013-11-15",
        "status": "A",
        "authorized_official_last_name": "FORSBERG",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "631-293-9700",
        "authorized_official_name_prefix": "Prof.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NY",
            "license": "5153209R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "33D0654179",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01287085",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Melville SC Anesthesia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2013; 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.