MEDICARE: MELISSA E NELSON ATC

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	2255A2300X	Athletic Trainer	25MT00140300	NJ

General Provider Information

NPI Number	:	1679517882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA E NELSON ATC

Provider Business Mailing Address
First Line	:	213 HUDSON AVE
Second Line	:
City	:	HOPATCONG
State	:	NJ
Zip	:	07843-1709
Country	:	US
Telephone Number	:	617-645-5733
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CENTRAL AVE
Second Line	:
City	:	OLD TAPPAN
State	:	NJ
Zip	:	07675-7340
Country	:	US
Telephone Number	:	201-784-1600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	09/22/2021

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