Healthcare Provider Details

I. General information

NPI: 1396861613
Provider Name (Legal Business Name): MR. MELVIN DANGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 W MAIN ST
MENDHAM NJ
07945-1230
US

IV. Provider business mailing address

66 BALDWIN AVE
NEWARK NJ
07108-1541
US

V. Phone/Fax

Practice location:
  • Phone: 973-543-5656
  • Fax: 973-543-5273
Mailing address:
  • Phone: 973-642-1699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: