Mark Melillo, MS, LCADC, RYT-200

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

37LC00252200 Issued in NJ

Practice address

1 Monument Drive
Princeton, NJ 08540-4014

Phone

(609) 924-8018

Fax

(609) 688-2045

NPI assigned

Apr 27, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Princeton/Corner House

  • Clinic/Center
  • Princeton, NJ
  • NPI 1720145410
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484265600000",
    "number": "1174978159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 LINCOLN PL",
            "address_2": "D",
            "city": "NORTH BRUNSWICK",
            "state": "NJ",
            "postal_code": "089024014",
            "telephone_number": "732-331-7796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MONUMENT DRIVE",
            "city": "PRINCETON",
            "state": "NJ",
            "postal_code": "085404014",
            "telephone_number": "609-924-8018",
            "fax_number": "609-688-2045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELILLO",
        "first_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "MS, LCADC, RYT-200",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-27",
        "last_updated": "2017-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37LC00252200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174978159",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mehta Bariatric Center
• Vishal Mehta, MD
• Robert F Meirowitz, MD
• Linda F. Meisel, LCSW
• Julia Melao
• Hayley Melinek, MS, CCC-SLP
• Ilona Melker, MSW
• Neil Melker, DDS
• Shula Melker, MA, LPC
• Hasan Memon, MD

• Addiction (Substance Use Disorder) Counselor in Princeton, NJ
• Providers in Princeton, NJ by specialty
• Addiction (Substance Use Disorder) Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.