Active NPI
Tyler Dean Melnicove, ATC, EMT
- Athletic Trainer
- Pittsgrove, NJ
National Provider Identifier
1316334733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2000025437
- Practice address
- 1132 Rainbow Cir
Pittsgrove, NJ 08318-9177 - Phone
- (609) 805-4695
- NPI assigned
- Apr 23, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2000025437 | NJ | Primary |
| Basic Emergency Medical Technician | 146N00000X | 608409 | NJ |
Addresses
Primary practice location
1132 Rainbow Cir
Pittsgrove, NJ 08318-9177
Mailing address
1132 Rainbow Cir
Pittsgrove, NJ 08318-9177
Phone (609) 805-4695
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Emergency Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 608409 | NJ | MD | Basic Emergency Medical Technician |
| 2000025437 | NJ | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474243200000",
"number": "1316334733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1132 RAINBOW CIR",
"city": "PITTSGROVE",
"state": "NJ",
"postal_code": "083189177",
"telephone_number": "609-805-4695"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1132 RAINBOW CIR",
"city": "PITTSGROVE",
"state": "NJ",
"postal_code": "083189177",
"telephone_number": "609-805-4695"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELNICOVE",
"first_name": "TYLER",
"middle_name": "DEAN",
"name_prefix": "Mr.",
"credential": "ATC, EMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-04-23",
"last_updated": "2016-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NJ",
"license": "2000025437",
"primary": true
},
{
"code": "146N00000X",
"taxonomy_group": "",
"desc": "Emergency Medical Technician, Basic",
"state": "NJ",
"license": "608409",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pittsgrove, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.