MEDICARE: LESLIE JEAN LAUFER LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	18KT01379600	NJ

General Provider Information

NPI Number	:	1164256384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE JEAN LAUFER LMT

Provider Business Mailing Address
First Line	:	1 MOHICAN PL
Second Line	:
City	:	LAKE HIAWATHA
State	:	NJ
Zip	:	07034-2812
Country	:	US
Telephone Number	:	646-427-8586
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 MADISON ST
Second Line	:
City	:	BOONTON
State	:	NJ
Zip	:	07005-2153
Country	:	US
Telephone Number	:	973-299-2430
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2024
Last Update Date	:	08/29/2024

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