MEDICARE: THE MODERN WOMAN

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
1	207VG0400X	Gynecology Physician

General Provider Information

NPI Number	:	1356298426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MODERN WOMAN

Provider Business Mailing Address
First Line	:	55 N GILBERT ST STE 1204
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07701-4955
Country	:	US
Telephone Number	:	732-808-3288
Fax Number	:	215-310-5457

Provider Business Practice Location Address
First Line	:	55 N GILBERT ST STE 1204
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07701-4955
Country	:	US
Telephone Number	:	732-808-3288
Fax Number	:	215-310-5457

Authorized Official
Title or Position	:	PHYSICIAN, OWNER
Name	:	DR. MELISSA BLACKBURN
Credential	:	DO
Telephone Number	:	215-873-9759

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/18/2026

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Directions to “THE MODERN WOMAN ” Practice Location

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