Provider Demographics
NPI:1033379961
Name:BOUFFARD, MELISSA WOODS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:WOODS
Last Name:BOUFFARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 MOUNT BETHEL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5127
Mailing Address - Country:US
Mailing Address - Phone:908-756-7999
Mailing Address - Fax:908-756-8017
Practice Address - Street 1:122 MOUNT BETHEL RD STE 1
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5127
Practice Address - Country:US
Practice Address - Phone:908-756-7999
Practice Address - Fax:908-756-8017
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00197800363A00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22-3824190OtherGROUP TAX ID #