Provider Demographics
NPI:1689496804
Name:AHERN, MELISSA MARY
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARY
Last Name:AHERN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ORCHARD ST APT 4R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-2264
Mailing Address - Country:US
Mailing Address - Phone:332-268-8043
Mailing Address - Fax:
Practice Address - Street 1:160 ORCHARD ST APT 4R
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-2264
Practice Address - Country:US
Practice Address - Phone:332-268-8043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist