Provider Demographics
NPI:1730278573
Name:MELLAS, DEAN P (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:P
Last Name:MELLAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 FRANKLIN AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1306
Mailing Address - Country:US
Mailing Address - Phone:201-560-0711
Mailing Address - Fax:201-560-0712
Practice Address - Street 1:784 FRANKLIN AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-1306
Practice Address - Country:US
Practice Address - Phone:201-560-0711
Practice Address - Fax:201-560-0712
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00099400363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ02217Medicare UPIN
NJQ02217Medicare UPIN