Healthcare Provider Details

I. General information

NPI: 1942021357
Provider Name (Legal Business Name): MELANIE CRYSTAL TRIANO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 KEARNY AVE
KEARNY NJ
07032-2703
US

IV. Provider business mailing address

504 7TH ST FL 2
HARRISON NJ
07029-2010
US

V. Phone/Fax

Practice location:
  • Phone: 201-998-7474
  • Fax:
Mailing address:
  • Phone: 201-889-5952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ15180500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: