Healthcare Provider Details

I. General information

NPI: 1972828531
Provider Name (Legal Business Name): MELISSA MORDECAI MSN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 BLACK HORSE PIKE STE 501
PLEASANTVILLE NJ
08232-2967
US

IV. Provider business mailing address

151 FRIES MILL RD STE 301
TURNERSVILLE NJ
08012-2016
US

V. Phone/Fax

Practice location:
  • Phone: 609-822-7979
  • Fax: 609-822-7980
Mailing address:
  • Phone: 856-374-1881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP01082
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ00376600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: