Healthcare Provider Details

I. General information

NPI: 1083449995
Provider Name (Legal Business Name): MELISSA DENNISTON APN -FAMILY PRACTICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18-20 LACKAWANNA PLZ STE 300
MONTCLAIR NJ
07042-3642
US

IV. Provider business mailing address

42 SUNNYSIDE TER
EAST ORANGE NJ
07018-2394
US

V. Phone/Fax

Practice location:
  • Phone: 347-209-0881
  • Fax: 973-869-2532
Mailing address:
  • Phone: 973-392-2058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15130800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: