Individual
MELISSA J GRIGSBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
150 BERGEN ST, NEWARK, NJ 07103-2496
(973) 972-0376
Mailing address
150 BERGEN ST # M229, NEWARK, NJ 07103-2496
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01095238A
IN
2086S0102X
Surgical Critical Care Physician
01095238A
IN
2086S0127X
Trauma Surgery Physician
Primary
25MA11944900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102139741
ANTHEM PTAN
IN
05
—
300099580
—
IN
Enumeration date
06/16/2016
Last updated
12/18/2024
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