Healthcare Provider Details

I. General information

NPI: 1265890578
Provider Name (Legal Business Name): MELANIE LEE MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 FRENCH ST
NEW BRUNSWICK NJ
08901-1935
US

IV. Provider business mailing address

341 PLAINFIELD AVE FLOOR 2
EDISON NJ
08817-3118
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-6241
  • Fax: 732-235-8127
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number000000000000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: