Healthcare Provider Details

I. General information

NPI: 1265760805
Provider Name (Legal Business Name): LEAT KUZNIAR N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 PASSAIC AVE
NUTLEY NJ
07110-2737
US

IV. Provider business mailing address

14 ELLSWORTH ST
CLIFTON NJ
07012-1104
US

V. Phone/Fax

Practice location:
  • Phone: 201-790-7212
  • Fax: 973-542-8292
Mailing address:
  • Phone: 201-757-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099-000017
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099.0000171
License Number StateVT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier099.0000171
Identifier TypeOTHER
Identifier StateVT
Identifier IssuerOFFICE OF PROFESSIONAL REGULATION

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: