1659722544 NPI number — MAUREEN G. MELLON

Table of content: MAUREEN G. MELLON (NPI 1659722544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659722544 NPI number — MAUREEN G. MELLON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MELLON
Provider First Name:
MAUREEN
Provider Middle Name:
G.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MELLON
Provider Other First Name:
MAUREEN
Provider Other Middle Name:
G.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1659722544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 KEARNEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNDHURST
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07071-1010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-715-4559
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
543 VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER MONTCLAIR
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07043-1881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-715-4559
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  37PC00351000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 16597223544 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1659722544 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1659722544 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1659722544 . This is a "OPTUM" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1659722544 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1659722544 . This is a "HBCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1659722544 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1659722544 . This is a "BEACON HEALTH" identifier . This identifiers is of the category "OTHER".




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