Healthcare Provider Details

I. General information

NPI: 1174028617
Provider Name (Legal Business Name): LESLIE ANN ECHOLS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 WESTFIELD AVE
CLARK NJ
07066-1323
US

IV. Provider business mailing address

259 WALNUT ST FL 1
WESTFIELD NJ
07090-3135
US

V. Phone/Fax

Practice location:
  • Phone: 732-396-7100
  • Fax:
Mailing address:
  • Phone: 702-563-7505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002591
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: