Provider Demographics
NPI:1639792161
Name:DUFFY, MELISSA (LMT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DUFFY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:MANGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:455 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1243
Mailing Address - Country:US
Mailing Address - Phone:201-870-1751
Mailing Address - Fax:
Practice Address - Street 1:455 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1243
Practice Address - Country:US
Practice Address - Phone:201-870-1751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01291000225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist