Provider Demographics
NPI:1548261605
Name:MELLUL, STEVEN D (DO, FACS)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:MELLUL
Suffix:
Gender:M
Credentials:DO, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:525 ROUTE 73 S
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9642
Mailing Address - Country:US
Mailing Address - Phone:856-334-8227
Mailing Address - Fax:856-334-8230
Practice Address - Street 1:525 ROUTE 73 S
Practice Address - Street 2:SUITE 305
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9642
Practice Address - Country:US
Practice Address - Phone:856-334-8227
Practice Address - Fax:856-334-8230
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB07476600207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0018198Medicaid
NJ070943TIAOtherMEDICARE PTAN
NJ0018198Medicaid