Provider Demographics
NPI:1699988501
Name:BUDDHA, MELISSA A (WHNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:BUDDHA
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 KLINE ST
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07640-1327
Mailing Address - Country:US
Mailing Address - Phone:201-767-7707
Mailing Address - Fax:201-767-7707
Practice Address - Street 1:58 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1263
Practice Address - Country:US
Practice Address - Phone:201-489-2255
Practice Address - Fax:201-489-4799
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420736-1363LW0102X
NJ26NJ00160700363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ139502ZB7QMedicare PIN