Individual
MELBA E OCTAVIANI-REYES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7224 BERGENLINE AVE, NORTH BERGEN, NJ 07047-5417
(201) 869-4603
Mailing address
9320 ROOSEVELT AVE # A, 2ND FLOOR, JACKSON HEIGHTS, NY 11372-7911
(718) 404-9109
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
14,814
PR
208000000X
Pediatrics Physician
Primary
25MA07711600
NJ
208000000X
Pediatrics Physician
262778
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03539879
—
NY
Enumeration date
10/03/2006
Last updated
04/11/2018
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