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NPI Code Detail

MEDICARE: MS. MELISSA DENNISTON APN -FAMILY PRACTICE

MEDICARE:  MS. MELISSA  DENNISTON  APN -FAMILY PRACTICE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner26NJ15130800NJ

General Provider Information

NPI Number : 1083449995
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MELISSA DENNISTON APN -FAMILY PRACTICE
Provider Business Mailing Address
First Line : 42 SUNNYSIDE TER
Second Line :
City : EAST ORANGE
State : NJ
Zip : 07018-2394
Country : US
Telephone Number : 973-392-2058
Fax Number :
Provider Business Practice Location Address
First Line : 18-20 LACKAWANNA PLZ STE 300
Second Line :
City : MONTCLAIR
State : NJ
Zip : 07042-3642
Country : US
Telephone Number : 347-209-0881
Fax Number : 973-869-2532
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2024
Last Update Date : 05/13/2026

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Directions to “ MS. MELISSA DENNISTON APN -FAMILY PRACTICE” Practice Location

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