Healthcare Provider Details

I. General information

NPI: 1649331521
Provider Name (Legal Business Name): LEONARD DEFIORE CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BLACK HORSE PIKE RT. 168
TURNERSVILLE NJ
08012
US

IV. Provider business mailing address

168 ELWOOD CT
SEWELL NJ
08080-1813
US

V. Phone/Fax

Practice location:
  • Phone: 609-405-8372
  • Fax:
Mailing address:
  • Phone: 609-405-8372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: