Healthcare Provider Details

I. General information

NPI: 1609516483
Provider Name (Legal Business Name): MELISSA L. OSOFSKY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 STATE ROUTE 66 FL 3
NEPTUNE NJ
07753-2645
US

IV. Provider business mailing address

22 COLONIAL CT
FAIR HAVEN NJ
07704-3238
US

V. Phone/Fax

Practice location:
  • Phone: 732-807-0800
  • Fax:
Mailing address:
  • Phone: 732-539-7214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number26NR09692900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NR09692900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: