Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 14,814 | PR |
Y | 208000000X | Pediatrician | 25MA07711600 | NJ |
N | 208000000X | Pediatrician | 262778 | NY |
NPI | 1003900689 |
---|---|
Provider Name | Melba E Octaviani-Reyes |
First Address | Jackson Heights, NY 11372-7911 |
Second Address | North Bergen, NJ 07047-5417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 11/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03539879 | (05) | NY |