Individual
MELISSA ELLISON FREDERIKSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
225 MILLBURN AVE, SUITE 210, MILLBURN, NJ 07041-1737
(973) 218-1511
(973) 218-1477
Mailing address
225 MILLBURN AVE, SUITE 210, MILLBURN, NJ 07041-1737
(973) 218-1511
(973) 218-1477
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
25MA06949500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8148007
—
NJ
Enumeration date
07/08/2006
Last updated
04/02/2015
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