Provider Demographics
NPI:1417774456
Name:GRUDIC, MELISSA (DNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GRUDIC
Suffix:
Gender:
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 TRIMBLE AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1833
Mailing Address - Country:US
Mailing Address - Phone:609-201-8556
Mailing Address - Fax:
Practice Address - Street 1:511 S ORANGE AVE # 2078
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-1342
Practice Address - Country:US
Practice Address - Phone:973-755-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15154800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health