Provider Demographics
NPI:1477997666
Name:VERNACCHIA, MELANIE ROSE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ROSE
Last Name:VERNACCHIA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RIVER AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5237
Mailing Address - Country:US
Mailing Address - Phone:732-886-4700
Mailing Address - Fax:732-886-4705
Practice Address - Street 1:600 RIVER AVE FL 3
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5237
Practice Address - Country:US
Practice Address - Phone:732-886-4700
Practice Address - Fax:732-886-4705
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00432200363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00513500OtherNJ CDS REGISTRATION
MV2891174OtherDEA