Healthcare Provider Details

I. General information

NPI: 1730907759
Provider Name (Legal Business Name): LEONETTI ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 LIVINGSTON AVE
NORTH BRUNSWICK NJ
08902-2443
US

IV. Provider business mailing address

602 LIVINGSTON AVE
NORTH BRUNSWICK NJ
08902-2443
US

V. Phone/Fax

Practice location:
  • Phone: 732-371-1089
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DOMENIC LEONETTI
Title or Position: MANAGER
Credential:
Phone: 732-371-1089