Provider Demographics
NPI:1699741892
Name:MELLODY, JOHN M (ATC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:MELLODY
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Gender:M
Credentials:ATC
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Mailing Address - Street 1:1 JETS DR
Mailing Address - Street 2:NEW YORK JETS, LLC
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1215
Mailing Address - Country:US
Mailing Address - Phone:973-549-4701
Mailing Address - Fax:973-549-4708
Practice Address - Street 1:1 JETS DR
Practice Address - Street 2:NEW YORK JETS, LLC
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1215
Practice Address - Country:US
Practice Address - Phone:973-549-4701
Practice Address - Fax:973-549-4708
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2013-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY000705-12255A2300X
NJ25MT000963002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer