Active NPI
Melrose Blake-Bethea, DPM
- Primary Podiatric Medicine Podiatrist
- Irvington, NJ
National Provider Identifier
1386674273
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Podiatric Medicine Podiatrist
- License
- 25MD00228700
- Practice address
- 774 Chancellor Ave
Irvington, NJ 07111-2955 - Phone
- (973) 375-5882
- Fax
- (973) 371-7990
- NPI assigned
- Jul 4, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Podiatric Medicine Podiatrist | 213EP1101X | 25MD00228700 | NJ | Primary |
Addresses
Primary practice location
774 Chancellor Ave
Irvington, NJ 07111-2955
Mailing address
774 Chancellor Ave
Irvington, NJ 07111-2955
Phone (973) 375-5882
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 25MD00228700 | Other | NJ | PODIATRY LICENSE |
| DO7146200 | Other | NJ | CDS PODIATRY |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386674273",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "774 CHANCELLOR AVE",
"city": "IRVINGTON",
"state": "NJ",
"postal_code": "071112955",
"telephone_number": "973-375-5882",
"fax_number": "973-371-7990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "774 CHANCELLOR AVE",
"city": "IRVINGTON",
"state": "NJ",
"postal_code": "071112955",
"telephone_number": "973-375-5882",
"fax_number": "973-371-7990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAKE-BETHEA",
"first_name": "MELROSE",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "213EP1101X",
"taxonomy_group": "",
"desc": "Podiatrist, Primary Podiatric Medicine",
"state": "NJ",
"license": "25MD00228700",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PODIATRY LICENSE",
"identifier": "25MD00228700",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CDS PODIATRY",
"identifier": "DO7146200",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Irvington, NJ
- Benjis Dad Transportation
- Karrelle Benoit, D.C
- Tabinah Beyah, MA PSYCHOLOGY
- Olubunmi E Bilewu, NURSE PRACTITIONER
- Bio-Medical Applications of New Jersey, Inc.
- Blessed Family Care Consultants LLC
- Blessed Hope Healthcare LLC
- Blessing Medical Transport LLC
- Blue Hope Supportive Care
- Blue Hope Supportive Care LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.