Individual
LISA M MELLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 W MAIN ST, SUITE B, FREEHOLD, NJ 07728-2579
(732) 294-2540
Mailing address
66 WEST GILBERT ST, REDBANK, NJ 07701
(732) 212-0051
(732) 212-0713
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MA59476
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6648401
—
NJ
Enumeration date
11/01/2006
Last updated
01/22/2008
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