Individual
MRS. MELISSA WOODS BOUFFARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
122 MOUNT BETHEL RD STE 1, WARREN, NJ 07059-5127
(908) 756-7999
(908) 756-8017
Mailing address
122 MOUNT BETHEL RD STE 1, WARREN, NJ 07059-5127
(908) 756-7999
(908) 756-8017
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
25MP00197800
NJ
363A00000X
Physician Assistant
Primary
25MP00197800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22-3824190
GROUP TAX ID #
NJ
Enumeration date
06/13/2008
Last updated
03/14/2024
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