Basic Information
| Provider Information | |||||||||
| NPI: | 1194198838 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERCY | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | SMITH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RN, PHD, CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 W GILBERT ST RM 1135 | ||||||||
| Address2: | |||||||||
| City: | TINTON FALLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077014947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434594120 | ||||||||
| FaxNumber: | 9739728947 | ||||||||
| Practice Location | |||||||||
| Address1: | 274 S ORANGE AVE FL 3 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071032419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737326040 | ||||||||
| FaxNumber: | 8629027874 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2015 | ||||||||
| LastUpdateDate: | 07/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 26NJ00290600 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.