Organization
MELVIN HENRY THORNTON II MD CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN BOUSKILA (CREDENTIALING MANAGER)
(646) 737-2470
Entity
Organization
Contact information
Practice address
161 MADISON AVE SUITE 4SW, NEW YORK, NY 10016-5459
(646) 737-2470
(718) 253-8117
Mailing address
24 GREENWICH AVE, CENTRAL VALLEY, NY 10917-3718
(646) 737-2470
(718) 253-8117
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
—
—
207VE0102X
Reproductive Endocrinology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
217796-1
STATE LICENSE
NY
Enumeration date
01/13/2021
Last updated
02/22/2023
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