Healthcare Provider Details

I. General information

NPI: 1780986646
Provider Name (Legal Business Name): JULIE M LEIZER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 PROFESSIONAL VIEW DR BUILDING 300
FREEHOLD NJ
07728-7904
US

IV. Provider business mailing address

312 PROFESSIONAL VIEW DR BUILDING 300
FREEHOLD NJ
07728-7904
US

V. Phone/Fax

Practice location:
  • Phone: 732-431-1616
  • Fax: 732-866-7962
Mailing address:
  • Phone: 732-431-1616
  • Fax: 732-866-7962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA08844700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: