Provider Demographics
NPI:1275747669
Name:LEEN, MARLA E (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:E
Last Name:LEEN
Suffix:
Gender:F
Credentials:DPM
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Other - First Name:
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Mailing Address - Street 1:21 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1307
Mailing Address - Country:US
Mailing Address - Phone:973-334-7772
Mailing Address - Fax:973-263-1915
Practice Address - Street 1:21 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1307
Practice Address - Country:US
Practice Address - Phone:973-334-7772
Practice Address - Fax:973-263-1915
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ1913213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ572933Medicare UPIN