Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 25MA03774600 | NJ |
Y | 207RP1001X | Pulmonary Disease | 25MA03774600 | NJ |
NPI | 1033171020 |
---|---|
Provider Name | Dr. Nicholas G. Melillo |
First Address | Edison, NJ 08820-3904 |
Second Address | Edison, NJ 08820-3945 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 11/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1824902 | (05) | NJ |
203711560 | TAX ID (01) | NJ |
222955187 | TAX ID (01) | NJ |
C52805 | (02) | NJ |