Provider Demographics
NPI:1225564776
Name:LEADING EDGE MEDICAL CENTER PC
Entity Type:Organization
Organization Name:LEADING EDGE MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-261-9445
Mailing Address - Street 1:550 KINDERKAMACK RD
Mailing Address - Street 2:STE. 203
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1500
Mailing Address - Country:US
Mailing Address - Phone:201-261-9445
Mailing Address - Fax:201-261-0058
Practice Address - Street 1:550 KINDERKAMACK RD
Practice Address - Street 2:STE. 203
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1500
Practice Address - Country:US
Practice Address - Phone:201-261-9445
Practice Address - Fax:201-261-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty