Healthcare Provider Details

I. General information

NPI: 1750468971
Provider Name (Legal Business Name): TANYA LEYKIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 UNDERCLIFF AVE
EDGEWATER NJ
07020-1282
US

IV. Provider business mailing address

471 UNDERCLIFF AVE
EDGEWATER NJ
07020-1282
US

V. Phone/Fax

Practice location:
  • Phone: 201-969-9350
  • Fax: 201-969-9764
Mailing address:
  • Phone: 201-969-9350
  • Fax: 201-969-9764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMA07859900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: