Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 22D101815100 | NJ |
NPI | 1104042803 |
---|---|
Provider Name | Dr. Leslie Ann Klardie |
First Address | Lebanon, NJ 08833-4115 |
Second Address | New Providence, NJ 07974-1511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 08/07/2007 |