MEDICARE: DR. LEAH S GENDLER M.D.

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	208600000X	Surgery Physician	25MA07906800	NJ
2	208600000X	Surgery Physician	25MA07906	NJ

General Provider Information

NPI Number	:	1306836127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEAH S GENDLER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 416457
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-6457
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 MADISON AVE # 152
Second Line	:	CAROL G. SIMON CANCER CENTER AT MMC
City	:	MORRISTOWN
State	:	NJ
Zip	:	07960-6136
Country	:	US
Telephone Number	:	973-971-4166
Fax Number	:	973-290-7152

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	02/12/2016

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