Provider Demographics
NPI:1114912052
Name:LESPINASSE, ANTOINE ALEXANDRA (MD)
Entity Type:Individual
Prefix:
First Name:ANTOINE
Middle Name:ALEXANDRA
Last Name:LESPINASSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANTOINE
Other - Middle Name:
Other - Last Name:DUVIVIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:194 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-1914
Mailing Address - Country:US
Mailing Address - Phone:973-746-0250
Mailing Address - Fax:
Practice Address - Street 1:1000 HADDONFIELD BERLIN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3520
Practice Address - Country:US
Practice Address - Phone:856-782-2212
Practice Address - Fax:856-782-2266
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07507600208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0024945Medicaid
MA2085801Medicaid
MA2085801Medicaid