Healthcare Provider Details

I. General information

NPI: 1134049000
Provider Name (Legal Business Name): LESLIE HENRY LAC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 E MAIN ST
MOORESTOWN NJ
08057-3378
US

IV. Provider business mailing address

689 W WALNUT LN APT A3
PHILADELPHIA PA
19144-3766
US

V. Phone/Fax

Practice location:
  • Phone: 856-283-0743
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAK001488
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00183500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: