Provider Demographics
NPI:1750468971
Name:LEYKIN, TANYA (MD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:
Last Name:LEYKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 UNDERCLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1282
Mailing Address - Country:US
Mailing Address - Phone:201-969-9350
Mailing Address - Fax:201-969-9764
Practice Address - Street 1:471 UNDERCLIFF AVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1282
Practice Address - Country:US
Practice Address - Phone:201-969-9350
Practice Address - Fax:201-969-9764
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07859900173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0132721Medicaid