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General NPI Number Information
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NPI Number | 1598768442
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Entity Type | Individual
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Provider Name | LESLIE SHREM M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 197 RIDGEDALE AVE SURGICAL CENTER AT CEDAR KNOLLS
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City | CEDAR KNOLLS
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State | NJ
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Zip | 07927
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Country | US
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Telephone | 973-292-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 3 OLMSTED LN
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City | MENDHAM
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State | NJ
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Zip | 07945-3058
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Country | US
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Telephone | 973-607-7815
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Fax | 973-543-2854
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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 | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | 25MA05660000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MA05660000
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License Number State | NJ
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