Healthcare Provider Details

I. General information

NPI: 1346614823
Provider Name (Legal Business Name): MELISSA ROSE LLAVE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA MOJAR APN

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 SOUTH AVENUE WEST
CRANFORD NJ
07016
US

IV. Provider business mailing address

27 SOUTH AVENUE WEST
CRANFORD NJ
07016
US

V. Phone/Fax

Practice location:
  • Phone: 908-275-3810
  • Fax: 908-275-8825
Mailing address:
  • Phone: 908-868-1277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00602200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: