Provider Demographics
NPI:1215564067
Name:HUGGINS, LEROY J
Entity Type:Individual
Prefix:MR
First Name:LEROY
Middle Name:J
Last Name:HUGGINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-0510
Mailing Address - Country:US
Mailing Address - Phone:973-826-7145
Mailing Address - Fax:
Practice Address - Street 1:64 GEORGE RUSSELL WAY
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2655
Practice Address - Country:US
Practice Address - Phone:973-703-3794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133N00000X, 133V00000X, 133VN1201X, 2255A2300X, 251C00000X, 261QC1800X, 261QD1600X, 373H00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist