NPIMap

Organization Active NPI

MKL Medical PLLC

  • Dermatology Physician
  • New York, NY
National Provider Identifier
1902328164
Registry record updated Mar 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
278951 Issued in NY
Legal business name
MKL MEDICAL PLLC
Practice address
29 W 17TH St FL 9
New York, NY 10011-5507
Phone
(917) 522-1825
Fax
(844) 758-3869
NPI assigned
Jul 10, 2017
Last updated
Mar 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2024

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

Authorized official

Name
Dr. Melissa Kanchanapoomi LevinNPI 1831488014
Title
Ceo
Phone
(917) 522-1825

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
Dermatology Physician 207N00000X 278951 NY Primary

Addresses

Primary practice location

29 W 17TH St FL 9
New York, NY 10011-5507

Mailing address

300 E 40TH St
New York, NY 10016-2188
Phone (310) 873-8864

National Provider Directory

National Provider Directory
Tax ID family
MKL Medical PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

300 E 40th St
New York, NY 10016
Phone (212) 905-0081

347 5th Ave
Rm 900B
New York, NY 10016
Phone (646) 412-5540

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1499644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710892800000",
    "number": "1902328164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E 40TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100162188",
            "telephone_number": "310-873-8864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 W 17TH ST FL 9",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100115507",
            "telephone_number": "917-522-1825",
            "fax_number": "844-758-3869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MKL MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-10",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "LEVIN",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "KANCHANAPOOMI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "917-522-1825",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "278951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; 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.