# MELVILLE SC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Melville SC Anesthesia
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679903470
- **Authorized official:** PROF. DANIEL FORSBERG PA-C (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (631) 293-9700

## Contact information

- **Practice address:** 1895 WALT WHITMAN RD, SUITE 10, MELVILLE, NY 11747-3031
- **Practice address phone:** (631) 293-9700
- **Practice address fax:** (631) 293-2021
- **Mailing address:** 1895 WALT WHITMAN RD, SUITE 10, MELVILLE, NY 11747-3031
- **Mailing address phone:** (631) 293-9700
- **Mailing address fax:** (631) 293-2021

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | 5153209R | NY | Yes |

## Other

- **Enumeration date:** 11/15/2013
- **Last updated:** 11/15/2013