Provider Demographics
NPI:1093740375
Name:LEIFER, ALDEN (MD)
Entity Type:Individual
Prefix:
First Name:ALDEN
Middle Name:
Last Name:LEIFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 BROADWAY
Mailing Address - Street 2:SUITE 114
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1422
Mailing Address - Country:US
Mailing Address - Phone:973-742-4747
Mailing Address - Fax:973-742-0629
Practice Address - Street 1:680 BROADWAY
Practice Address - Street 2:SUITE 114
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1422
Practice Address - Country:US
Practice Address - Phone:973-742-4747
Practice Address - Fax:973-742-0629
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46643207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0357405Medicaid
NJ058625OtherMEDICARE PTAN
NJ058625OtherMEDICARE PTAN
C56551Medicare UPIN