1225022239 NPI number — JOHN LESLIE STEELE PA C

Table of content: JOHN LESLIE STEELE PA C (NPI 1225022239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225022239 NPI number — JOHN LESLIE STEELE PA C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEELE
Provider First Name:
JOHN
Provider Middle Name:
LESLIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225022239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4059
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07474-4059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-826-8291
Provider Business Mailing Address Fax Number:
855-834-5435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4215 EDGEWATER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32804-2206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-539-2000
Provider Business Practice Location Address Fax Number:
407-398-0050
Provider Enumeration Date:
09/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  PA2680 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: E3712Z . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 290251600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108879500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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