Healthcare Provider Details

I. General information

NPI: 1023096575
Provider Name (Legal Business Name): GREGORY SCOTT LESSER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218C SUNSET RD
WILLINGBORO NJ
08046-1104
US

IV. Provider business mailing address

318E WESTFIELD AVE
ROSELLE PARK NJ
07204-2361
US

V. Phone/Fax

Practice location:
  • Phone: 609-877-0400
  • Fax: 609-877-3542
Mailing address:
  • Phone: 908-245-2229
  • Fax: 908-245-2384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD424644
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA074450
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: