Provider Demographics
NPI:1235149022
Name:ROSENTHAL, LESLIE S (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:S
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7313 VENTNOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:VENTNOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:609-822-1390
Practice Address - Street 1:7313 VENTNOR AVE
Practice Address - Street 2:
Practice Address - City:VENTNOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08406-1958
Practice Address - Country:US
Practice Address - Phone:609-441-2199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA47847207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2230909Medicaid
R0572501Medicare ID - Type Unspecified
D06931Medicare UPIN
NJ2230909Medicaid