Basic Information
| Provider Information | |||||||||
| NPI: | 1982907820 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MELENDEZ | ||||||||
| FirstName: | AXEL | ||||||||
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| Credential: | MS, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 GRAHAM ST | ||||||||
| Address2: | UNIT B | ||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073073328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235962676 | ||||||||
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| Practice Location | |||||||||
| Address1: | 420 LEXINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 101700002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129730655 | ||||||||
| FaxNumber: | 2129730656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2010 | ||||||||
| LastUpdateDate: | 12/15/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 001980-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.