Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080A0000X | Adolescent Medicine | 26NJ00753300 | NJ |
Y | 363L00000X | Nurse Practitioner | 26NJ00753300 | NJ |
NPI | 1073030953 |
---|---|
Provider Name | Dr. Erin Leigh Leonard |
First Address | Wyckoff, NJ 07481 |
Second Address | Glen Rock, NJ 07452 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2017 |
Last Update Date | 22/05/2019 |