Healthcare Provider Details

I. General information

NPI: 1356203939
Provider Name (Legal Business Name): NIKOLAS ALEXANDER LEON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 KENTUCKY AVE
NORTH MIDDLETOWN NJ
07748-5346
US

IV. Provider business mailing address

109 BEDFORD AVE
ISELIN NJ
08830-2417
US

V. Phone/Fax

Practice location:
  • Phone: 732-947-7541
  • Fax:
Mailing address:
  • Phone: 917-514-7022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: