Healthcare Provider Details

I. General information

NPI: 1467626317
Provider Name (Legal Business Name): DR. MARK D. LEODORI, D.P.M.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 UNION BLVD
TOTOWA NJ
07512-2663
US

IV. Provider business mailing address

194 UNION BLVD
TOTOWA NJ
07512-2663
US

V. Phone/Fax

Practice location:
  • Phone: 973-790-1303
  • Fax: 973-790-5033
Mailing address:
  • Phone: 973-790-1303
  • Fax: 973-790-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD1292
License Number StateNJ

VIII. Authorized Official

Name: DR. MARK D LEODORI
Title or Position: PRESIDENT
Credential: D.P.M.,P.A.
Phone: 973-790-1303