Provider Demographics
NPI:1164410742
Name:AUFSEESER, LESLIE S (DPM)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:S
Last Name:AUFSEESER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1253
Mailing Address - Country:US
Mailing Address - Phone:732-367-5151
Mailing Address - Fax:732-905-5160
Practice Address - Street 1:1700 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1253
Practice Address - Country:US
Practice Address - Phone:732-367-5151
Practice Address - Fax:732-905-5160
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-08
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD001054213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0911208Medicaid
NJT44824Medicare UPIN
NJ178883Medicare PIN
NJ0911208Medicaid
NJ0354140001Medicare NSC