MEDICARE: MS. NIEVES LEON SR. HAIR LOSS SPECIALIST

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	1744P3200X	Prosthetics Case Management	32WA06800800	NJ

General Provider Information

NPI Number	:	1174173793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NIEVES LEON SR. HAIR LOSS SPECIALIST

Provider Business Mailing Address
First Line	:	806 LIVINGSTON AVE
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-2354
Country	:	US
Telephone Number	:	732-247-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	806 LIVINGSTON AVE
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-2354
Country	:	US
Telephone Number	:	732-247-7000
Fax Number	:

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

Provider Enumeration Date	:	09/16/2019
Last Update Date	:	10/30/2019

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