Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 26NJ00799100 | NJ |
NPI | 1003324526 |
---|---|
Provider Name | Mrs. Melissa Matina |
First Address | Clifton, NJ 07012-1646 |
Second Address | Clifton, NJ 07012-1646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2018 |
Last Update Date | 10/02/2020 |