Healthcare Provider Details

I. General information

NPI: 1710135785
Provider Name (Legal Business Name): SCOTT JASON MELLENDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PATERSON ST # 3100
NEW BRUNSWICK NJ
08901-1962
US

IV. Provider business mailing address

41 LIBERTY WAY
SOUTH BOUND BROOK NJ
08880-1494
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-6153
  • Fax:
Mailing address:
  • Phone: 914-420-5680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA07582100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number25MA07582100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: