Healthcare Provider Details

I. General information

NPI: 1407590847
Provider Name (Legal Business Name): MELISSA GRILLO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 04/22/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 MEMORIAL PKWY STE 201
PHILLIPSBURG NJ
08865-2748
US

IV. Provider business mailing address

185 ROSEBERRY ST FARLEY BLDG. 2ND FLOOR
PHILLIPSBURG NJ
08865
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-7246
  • Fax: 866-291-6192
Mailing address:
  • Phone: 908-847-2621
  • Fax: 908-847-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ01268400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: