Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 057243 | NY |
Y | 1223P0700X | Prosthodontist | 22DI02617400 | NJ |
N | 1223P0700X | Prosthodontist | DS040932 | PA |
NPI | 1215348412 |
---|---|
Provider Name | Dr. Austin Leong |
First Address | Cherry Hill, NJ 08003-2148 |
Second Address | Cherry Hill, NJ 08003-2148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2014 |
Last Update Date | 23/08/2016 |