Provider Demographics
NPI:1073564340
Name:MELMAN, SHOSHANA T (MD)
Entity type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:T
Last Name:MELMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHOSHANA
Other - Middle Name:
Other - Last Name:TROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42 E LAUREL RD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1354
Mailing Address - Country:US
Mailing Address - Phone:856-566-7036
Mailing Address - Fax:856-566-6108
Practice Address - Street 1:42 E LAUREL RD
Practice Address - Street 2:SUITE 1100
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-7036
Practice Address - Fax:856-566-6108
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032689E208000000X
NJ25MA04653700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5016304Medicaid
NJE64102Medicare UPIN
PA446722Medicare ID - Type Unspecified
PAE64102Medicare UPIN
NJ5016304Medicaid