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General NPI Number Information
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NPI Number | 1285712950
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Entity Type | Individual
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Provider Name | GLENN R LESLIE D.O.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 10 FRANKLIN TPKE
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City | MAHWAH
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State | NJ
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Zip | 07430-1304
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Country | US
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Telephone | 201-529-0033
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Fax | 201-529-5913
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Provider Business Mailing Address
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Address Line | 10 FRANKLIN TPKE MAHWAH MEDICAL
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City | MAHWAH
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State | NJ
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Zip | 07430
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Country | US
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Telephone | 201-529-3380
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Fax | 201-529-5913
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MB42681
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License Number State | NJ
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