NPIMap

Individual provider Active NPI

Melissa Petronella, PA-C

  • Physician Assistant
  • Clark, NJ
National Provider Identifier
1619108172
Registry record updated May 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00221000 Issued in NJ
Practice address
1255 Raritan Rd Ste F4B
Clark, NJ 07066
Phone
(848) 206-0078
Fax
(848) 206-0078
NPI assigned
Jul 31, 2009
Last updated
May 16, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 16, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 25MP00221000 NJ Primary
Surgical Physician Assistant 363AS0400X 25MP00221000 NJ

Addresses

Primary practice location

1255 Raritan Rd Ste F4B
Clark, NJ 07066

Mailing address

1345 RXR PLZ FL 13
Uniondale, NY 11556-1301
Phone (516) 453-0435

Other practice location 1

308 Willow Ave
Hoboken, NJ 07030-3808
Phone (201) 418-1900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100414000805 NJ Practitioner - Physician Assistant 7719014232 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atlantic Advanced Urgent CareGroup PAC ID 4385986330, 44 clinicians
Rwjbh Emergency Medicine Associates, LLCGroup PAC ID 0941612840, 826 clinicians

Practice addresses (Care Compare)

140 Central Ave
Clark, NJ 07066-1121
Phone (732) 499-0606

225 Williamson St
Elizabeth, NJ 07202-3625
Phone (908) 994-5422

333 US Hwy 46
Suite 106
Mountain Lakes, NJ 07046-1741
Phone (973) 939-6220

865 Stone St
Rahway, NJ 07065-2742
Phone (732) 381-4200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
25MP00221000NJMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Humc Opco LLC Current Accepting new patients
William R. Collini, M.D., P.a. Past Accepting new patients
Jersey Irish Medical PastSince Oct 26, 2019 Accepting new patients
Hoboken Emergency Physicians, PC Past Accepting new patients

Locations

308 Willow Ave
Hoboken, NJ 07030
Phone (201) 418-1574

Interoperability endpoints

  • Direct secure messaging: eun.melissapetronella@128645.advancedmd-direct.com
  • Direct secure messaging: melissa.petronella@direct.hobokenumc.md
  • Direct secure messaging: mpetronella530991@direct.ahsys.org

Organizations & group practices 12

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1248998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557964800000",
    "number": "1619108172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1345 RXR PLZ FL 13",
            "city": "UNIONDALE",
            "state": "NY",
            "postal_code": "115561301",
            "telephone_number": "516-453-0435",
            "fax_number": "646-846-3283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 RARITAN RD STE F4B",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "07066",
            "telephone_number": "848-206-0078",
            "fax_number": "848-206-0078"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "308 Willow Ave",
            "address_purpose": "LOCATION",
            "city": "Hoboken",
            "state": "NJ",
            "postal_code": "070303808",
            "country_code": "US",
            "telephone_number": "201-418-1900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRONELLA",
        "first_name": "MELISSA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-31",
        "last_updated": "2019-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00221000",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NJ",
            "license": "25MP00221000",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clark, NJ

Sources for this page

Verify at the official NPI Registry.