Provider Demographics
NPI:1235177445
Name:FRIEDMAN, LESLIE (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N CHURCH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2498
Mailing Address - Country:US
Mailing Address - Phone:856-235-2620
Mailing Address - Fax:856-235-0842
Practice Address - Street 1:301 N CHURCH ST
Practice Address - Street 2:STE 201
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2498
Practice Address - Country:US
Practice Address - Phone:856-235-2620
Practice Address - Fax:856-235-0842
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA005127152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0523887000OtherKEYSTONE HPE
NJ88633OtherAETNA
NJ0523887000OtherAMERIHEALTH ADMINISTRATOR
NJ223294272OtherUNITED HEALTHCARE
NJ223294272OtherQUALCARE
NJ223294272-008OtherCIGNA
NJ4995104Medicaid
NJ689196OtherAMERIHEALTH PERSONAL CHOI
NJ0523887000OtherAMERIHEALTH HMO
NJ223294272OtherHORIZON BCBSNJ
NJ223294272OtherINTERGROUP
NJ223294272OtherNJ CARPENTERS
NJ223294272OtherVSP
NJ22839OtherAMERIGROUP
NJ223294272OtherTRICARE
NJ2K6571OtherHEALTHNET
NJ0523887000OtherAMERIHEALTH HMO
NJ0523887000OtherAMERIHEALTH ADMINISTRATOR
NJ223294272OtherQUALCARE
NJ0945160001Medicare NSC