Active NPI
Lisa M Mellor
- Family Medicine Physician
- Freehold, NJ
National Provider Identifier
1780761387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MA59476
- Practice address
- 1001 W Main St
Suite B
Freehold, NJ 07728-2579 - Phone
- (732) 294-2540
- NPI assigned
- Nov 1, 2006
- Last updated
- Jan 22, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MA59476 | NJ | Primary |
Addresses
Primary practice location
1001 W Main St
Suite B
Freehold, NJ 07728-2579
Mailing address
66 West Gilbert St
Redbank, NJ 07701
Phone (732) 212-0051
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6648401 | Medicaid | NJ |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA59476 | NJ | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rutgers Health-PCC Monument Square | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- New Brunswick, NJ
- NPI 1912089731
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200960000000",
"number": "1780761387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "66 WEST GILBERT ST",
"city": "REDBANK",
"state": "NJ",
"postal_code": "07701",
"telephone_number": "732-212-0051",
"fax_number": "732-212-0713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 W MAIN ST",
"address_2": "SUITE B",
"city": "FREEHOLD",
"state": "NJ",
"postal_code": "077282579",
"telephone_number": "732-294-2540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELLOR",
"first_name": "LISA",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2008-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NJ",
"license": "MA59476",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6648401",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Freehold, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.