Provider Demographics
NPI:1326043647
Name:MELLK, HARLAN M (M D)
Entity Type:Individual
Prefix:DR
First Name:HARLAN
Middle Name:M
Last Name:MELLK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1917
Mailing Address - Country:US
Mailing Address - Phone:973-379-3838
Mailing Address - Fax:
Practice Address - Street 1:127 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1917
Practice Address - Country:US
Practice Address - Phone:973-379-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02105300207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2867702Medicaid
NJC52998Medicare UPIN
NJ2867702Medicaid