Provider Demographics
NPI:1306836127
Name:GENDLER, LEAH S (MD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:S
Last Name:GENDLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MADISON AVE # 152
Practice Address - Street 2:CAROL G. SIMON CANCER CENTER AT MMC
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-971-4166
Practice Address - Fax:973-290-7152
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07906800208600000X
NJ25MA07906208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ091236M7JMedicare ID - Type Unspecified
I16676Medicare UPIN