Active NPI
Lisa A. Mellman, M.D.
- Psychiatry Physician
- Ridgewood, NJ
National Provider Identifier
1629101282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 154094-1
- Practice address
- 76 W Ridgewood Ave
Ridgewood, NJ 07450-3198 - Phone
- (917) 620-6010
- NPI assigned
- Mar 13, 2007
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 154094-1 | NY | Primary |
Addresses
Primary practice location
76 W Ridgewood Ave
Ridgewood, NJ 07450-3198
Mailing address
161 Fort Washington Ave
New York, NY 10032-3729
Phone (917) 620-6010
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 2, 2016 through Feb 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 154094-1 | NY | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769040000000",
"number": "1629101282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "161 FORT WASHINGTON AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323729",
"telephone_number": "917-620-6010",
"fax_number": "212-305-1343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "76 W RIDGEWOOD AVE",
"city": "RIDGEWOOD",
"state": "NJ",
"postal_code": "074503198",
"telephone_number": "917-620-6010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELLMAN",
"first_name": "LISA",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-13",
"last_updated": "2026-01-22",
"certification_date": "2026-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NY",
"license": "154094-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ridgewood, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.