Healthcare Provider Details

I. General information

NPI: 1770656761
Provider Name (Legal Business Name): OCTAVIO MELENDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: OCTAVIO MELENDEZ-CABRERA M.D.

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 66TH STREET
WEST NEW YORK NJ
07093
US

IV. Provider business mailing address

718 TEANECK ROAD
TEANECK NJ
07666-0000
US

V. Phone/Fax

Practice location:
  • Phone: 201-861-9229
  • Fax: 201-861-9272
Mailing address:
  • Phone: 201-833-7265
  • Fax: 201-227-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number10122
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA08597600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: