Provider Demographics
NPI:1205202660
Name:RASS, LEAH (NP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:RASS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4810
Mailing Address - Country:US
Mailing Address - Phone:732-364-9696
Mailing Address - Fax:732-367-0758
Practice Address - Street 1:290 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4810
Practice Address - Country:US
Practice Address - Phone:732-364-9696
Practice Address - Fax:732-367-0758
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2297140363L00000X
NJ26NJ00661700363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00661700OtherADVANCED PRACTICE NURSE
MARN2297140OtherBOARD OF REGISTRATION IN NURSING