Healthcare Provider Details

I. General information

NPI: 1033055033
Provider Name (Legal Business Name): AVIVA LEAH MENASHY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 N BROADWAY
YONKERS NY
10701-1301
US

IV. Provider business mailing address

12 IROQUOIS PL
LAKEWOOD NJ
08701-1134
US

V. Phone/Fax

Practice location:
  • Phone: 914-798-8971
  • Fax:
Mailing address:
  • Phone: 732-552-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberM24970717355972
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: