Provider Demographics
NPI:1609950906
Name:MELSKY, LISA (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MELSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELISAVETA
Other - Middle Name:
Other - Last Name:MELSKAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:87 BERDAN AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3210
Mailing Address - Country:US
Mailing Address - Phone:973-692-9631
Mailing Address - Fax:973-692-1112
Practice Address - Street 1:87 BERDAN AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3210
Practice Address - Country:US
Practice Address - Phone:973-692-9631
Practice Address - Fax:973-692-1112
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG87237Medicare UPIN