Provider Demographics
NPI:1710971676
Name:MELENDEZ, GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 BROAD ST
Mailing Address - Street 2:2ND FLOOR, STE 9
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1615
Mailing Address - Country:US
Mailing Address - Phone:973-614-9500
Mailing Address - Fax:
Practice Address - Street 1:642 BROAD ST
Practice Address - Street 2:2ND FLOOR, STE 9
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1615
Practice Address - Country:US
Practice Address - Phone:973-614-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05874300207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5508801Medicaid
NJF56781Medicare UPIN
NJ744617Medicare ID - Type Unspecified