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General NPI Number Information
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NPI Number | 1417774456
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Entity Type | Individual
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Provider Name | MELISSA GRUDIC DNP, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/23/2024
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 511 S ORANGE AVE # 2078
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City | NEWARK
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State | NJ
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Zip | 07103-1342
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Country | US
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Telephone | 973-755-2887
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Fax |
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Provider Business Mailing Address
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Address Line | 165 TRIMBLE AVE
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City | CLIFTON
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State | NJ
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Zip | 07011-1833
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Country | US
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Telephone | 609-201-8556
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ15154800
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License Number State | NJ
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