Healthcare Provider Details

I. General information

NPI: 1811386741
Provider Name (Legal Business Name): LEONARD SISKIN, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 US HIGHWAY 22 SUITE 6B
GREEN BROOK NJ
08812-1756
US

IV. Provider business mailing address

326 US HIGHWAY 22 SUITE 6B
GREEN BROOK NJ
08812-1756
US

V. Phone/Fax

Practice location:
  • Phone: 732-752-6606
  • Fax: 732-752-6643
Mailing address:
  • Phone: 732-752-6606
  • Fax: 732-752-6643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT00520400
License Number StateNJ

VIII. Authorized Official

Name: LEONARD SISKIN
Title or Position: PRESIDENT
Credential: DC
Phone: 732-752-6606