Healthcare Provider Details

I. General information

NPI: 1851342976
Provider Name (Legal Business Name): PHILIP RAPHAEL LESORGEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 KINDERKAMACK RD STE 200
ORADELL NJ
07649-1602
US

IV. Provider business mailing address

680 KINDERKAMACK RD STE 200
ORADELL NJ
07649-1602
US

V. Phone/Fax

Practice location:
  • Phone: 201-666-4200
  • Fax:
Mailing address:
  • Phone: 201-666-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number43936
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: