Healthcare Provider Details

I. General information

NPI: 1609875251
Provider Name (Legal Business Name): TODD OWEN LEVENTHAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2005
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 CENTRAL AVE STE 101
NEW PROVIDENCE NJ
07974-1547
US

IV. Provider business mailing address

571 CENTRAL AVE STE 101
NEW PROVIDENCE NJ
07974-1547
US

V. Phone/Fax

Practice location:
  • Phone: 908-464-4600
  • Fax: 908-464-4737
Mailing address:
  • Phone: 908-464-4600
  • Fax: 908-464-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMA66963
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: