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General NPI Number Information
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NPI Number | 1356298426
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Entity Type | Organization
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Legal Business Name | THE MODERN WOMAN
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Dates
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Enumeration Date | 03/16/2026
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Last Update Date | 03/18/2026
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Provider Practice Location Address
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Address Line | 55 N GILBERT ST STE 1204
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City | TINTON FALLS
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State | NJ
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Zip | 07701-4955
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Country | US
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Telephone | 732-808-3288
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Fax | 215-310-5457
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Provider Business Mailing Address
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Address Line | 55 N GILBERT ST STE 1204
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City | TINTON FALLS
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State | NJ
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Zip | 07701-4955
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Country | US
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Telephone | 732-808-3288
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Fax | 215-310-5457
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Authorized Official
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Title or Position | PHYSICIAN, OWNER
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Name | DR. MELISSA BLACKBURN
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Credential | DO
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Telephone | 215-873-9759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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