Healthcare Provider Details

I. General information

NPI: 1114912052
Provider Name (Legal Business Name): ANTOINE ALEXANDRA LESPINASSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANTOINE DUVIVIER

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HADDONFIELD BERLIN RD SUITE 210
VOORHEES NJ
08043-3520
US

IV. Provider business mailing address

194 HIGHLAND AVE
MONTCLAIR NJ
07042-1914
US

V. Phone/Fax

Practice location:
  • Phone: 856-782-2212
  • Fax: 856-782-2266
Mailing address:
  • Phone: 973-746-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07507600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number25MA07507600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: