Individual
GORDON E MELVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3900 PARK AVE, STE 107, EDISON, NJ 08820-3032
(732) 548-6800
(732) 548-6290
Mailing address
579A CRANBURY RD, EAST BRUNSWICK, NJ 08816-5426
(732) 390-0040
(732) 390-1856
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
25MA04658000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300009505
RAILROAD MEDICARE - EDISON
NJ
01
—
300025888
RAILROAD MEDICARE - BRIDGEWATER
NJ
01
—
300102255
RAILROAD MEDICARE - WARREN
NJ
05
—
5144302
—
NJ
Enumeration date
06/24/2005
Last updated
12/13/2016
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