Provider Demographics
NPI:1346434081
Name:REILLY, MELISSA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LYNN
Last Name:REILLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:532 LAFAYETTE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-4411
Mailing Address - Country:US
Mailing Address - Phone:973-940-0423
Mailing Address - Fax:973-940-0399
Practice Address - Street 1:272 ROUTE 206 NORTH
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NJ
Practice Address - Zip Code:07821
Practice Address - Country:US
Practice Address - Phone:973-347-2273
Practice Address - Fax:973-347-3238
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2012-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08437400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ188162Medicare PIN