Healthcare Provider Details

I. General information

NPI: 1598768442
Provider Name (Legal Business Name): LESLIE SHREM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 RIDGEDALE AVE SURGICAL CENTER AT CEDAR KNOLLS
CEDAR KNOLLS NJ
07927
US

IV. Provider business mailing address

3 OLMSTED LN
MENDHAM NJ
07945-3058
US

V. Phone/Fax

Practice location:
  • Phone: 973-292-0700
  • Fax:
Mailing address:
  • Phone: 973-607-7815
  • Fax: 973-543-2854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number25MA05660000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA05660000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: