1184618936 NPI number — MRS. KAREN B LEANOS P.T.

Table of content: MRS. KAREN B LEANOS P.T. (NPI 1184618936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184618936 NPI number — MRS. KAREN B LEANOS P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEANOS
Provider First Name:
KAREN
Provider Middle Name:
B
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

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:
1184618936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 FLINTLOCK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG VALLEY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07853-3023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-479-2774
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
272 ROUTE 206
Provider Second Line Business Practice Location Address:
C-2
Provider Business Practice Location Address City Name:
FLANDERS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07836-9081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-927-3034
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2005

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: 225100000X , with the licence number:  QA01928 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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