Healthcare Provider Details

I. General information

NPI: 1689087686
Provider Name (Legal Business Name): MELTEM ATES DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 PROSPECT AVE STE 16
HACKENSACK NJ
07601-1876
US

IV. Provider business mailing address

1011 CLIFTON AVE
CLIFTON NJ
07013-3518
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-0505
  • Fax:
Mailing address:
  • Phone: 973-955-0260
  • Fax: 973-246-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN006922
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00353500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier05339726
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: