Individual
MELROSE BLAKE-BETHEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
774 CHANCELLOR AVE, IRVINGTON, NJ 07111-2955
(973) 375-5882
(973) 371-7990
Mailing address
774 CHANCELLOR AVE, IRVINGTON, NJ 07111-2955
(973) 375-5882
(973) 371-7990
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
25MD00228700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MD00228700
PODIATRY LICENSE
NJ
01
—
DO7146200
CDS PODIATRY
NJ
Enumeration date
07/04/2006
Last updated
07/08/2007
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