Healthcare Provider Details

I. General information

NPI: 1306928510
Provider Name (Legal Business Name): LESLIE DONALD WEINSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ANDERSON ST
HACKENSACK NJ
07601-4508
US

IV. Provider business mailing address

15 ANDERSON ST
HACKENSACK NJ
07601-4508
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-3355
  • Fax: 201-487-0960
Mailing address:
  • Phone: 201-487-3355
  • Fax: 201-487-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA02212200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: