Healthcare Provider Details

I. General information

NPI: 1205202660
Provider Name (Legal Business Name): LEAH RASS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 RIVER AVE
LAKEWOOD NJ
08701-4810
US

IV. Provider business mailing address

290 RIVER AVE
LAKEWOOD NJ
08701-4810
US

V. Phone/Fax

Practice location:
  • Phone: 732-364-9696
  • Fax: 732-367-0758
Mailing address:
  • Phone: 732-364-9696
  • Fax: 732-367-0758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2297140
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number26NJ00661700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: