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General NPI Number Information
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NPI Number | 1770656761
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Entity Type | Individual
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Provider Name | OCTAVIO MELENDEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 419 66TH STREET
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City | WEST NEW YORK
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State | NJ
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Zip | 07093
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Country | US
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Telephone | 201-861-9229
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Fax | 201-861-9272
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Provider Business Mailing Address
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Address Line | 718 TEANECK ROAD
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City | TEANECK
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State | NJ
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Zip | 07666-0000
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Country | US
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Telephone | 201-833-7265
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Fax | 201-227-6207
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 10122
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MA08597600
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License Number State | NJ
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