Provider Demographics
NPI:1033171020
Name:MELILLO, NICHOLAS G (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:G
Last Name:MELILLO
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 1:2 LINCOLN HWY
Mailing Address - Street 2:STE 302
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3904
Mailing Address - Country:US
Mailing Address - Phone:732-906-0091
Mailing Address - Fax:732-906-0249
Practice Address - Street 1:106 JAMES ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3945
Practice Address - Country:US
Practice Address - Phone:732-906-0091
Practice Address - Fax:732-906-0249
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03774600207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222955187OtherTAX ID
NJ1824902Medicaid
NJ203711560OtherTAX ID
NJ222955187OtherTAX ID
NJ52047Medicare ID - Type UnspecifiedPROVIDER ID