Provider Demographics
NPI:1114903135
Name:LEONTI, VINCENT JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOSEPH
Last Name:LEONTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 FRANKLIN CORNER RD STE 101B
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2527
Mailing Address - Country:US
Mailing Address - Phone:609-512-1468
Mailing Address - Fax:609-512-1546
Practice Address - Street 1:134 FRANKLIN CORNER RD STE 101B
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2527
Practice Address - Country:US
Practice Address - Phone:609-512-1468
Practice Address - Fax:609-512-1546
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD462584207Q00000X
NY151611207Q00000X, 207P00000X
NJ25MA09912800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00845703Medicaid
NYRB5962Medicare PIN
NYB82470Medicare UPIN
NYJ400037549Medicare PIN