Provider Demographics
NPI:1235908997
Name:CUBALA, MELISSA ROE (APN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROE
Last Name:CUBALA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 WINDSOR CIR
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-4354
Mailing Address - Country:US
Mailing Address - Phone:201-660-2370
Mailing Address - Fax:
Practice Address - Street 1:6 FOREST AVE STE 202
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5245
Practice Address - Country:US
Practice Address - Phone:201-381-3810
Practice Address - Fax:201-381-3811
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14969300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty