Healthcare Provider Details

I. General information

NPI: 1689734055
Provider Name (Legal Business Name): MELISSA LEYVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 POLIFLY RD STE 102
HACKENSACK NJ
07601-1771
US

IV. Provider business mailing address

331 NEWMAN SPRINGS ROAD BLDG. 2, SUITE 220
RED BANK NJ
07701
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-8840
  • Fax: 201-441-9949
Mailing address:
  • Phone: 732-807-0877
  • Fax: 201-751-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number25MA08013700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: