Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 25MB09393900 | NJ |
Y | 207Q00000X | Family Doctor | 25MB09393900 | NJ |
NPI | 1255628707 |
---|---|
Provider Name | Dr. Joseph J Melograno JR. |
First Address | Boston, MA 02241-6457 |
Second Address | Morristown, NJ 07960-6422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2011 |
Last Update Date | 09/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0441023 | (05) | NJ |