Provider Demographics
NPI:1033116769
Name:MELAMED, MARC SANFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:SANFORD
Last Name:MELAMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 GODWIN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1969
Mailing Address - Country:US
Mailing Address - Phone:201-689-7755
Mailing Address - Fax:201-689-0521
Practice Address - Street 1:44 GODWIN AVE STE 201
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1959
Practice Address - Country:US
Practice Address - Phone:201-689-7755
Practice Address - Fax:201-689-0387
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35050207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1328808Medicaid
NJ156650OtherONE HEALTH
NJ2189501OtherAETNA
NJ1K3902OtherHEALTHNET
NJ1328808Medicaid
NJ156650OtherONE HEALTH