Healthcare Provider Details

I. General information

NPI: 1437015997
Provider Name (Legal Business Name): MS. LEONIDA ISUFAJ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 FRANKLIN AVE
NUTLEY NJ
07110-1284
US

IV. Provider business mailing address

315 LINCOLN AVE
LYNDHURST NJ
07071-2205
US

V. Phone/Fax

Practice location:
  • Phone: 973-916-0002
  • Fax:
Mailing address:
  • Phone: 201-532-2125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15498500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: