Provider Demographics
NPI:1356312649
Name:DELEASA, LEONARD VINCENT (DC)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:VINCENT
Last Name:DELEASA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 HACKENSACK ST
Mailing Address - Street 2:
Mailing Address - City:CARLSTADT
Mailing Address - State:NJ
Mailing Address - Zip Code:07072-1016
Mailing Address - Country:US
Mailing Address - Phone:201-935-7833
Mailing Address - Fax:201-935-3073
Practice Address - Street 1:306 HACKENSACK ST
Practice Address - Street 2:
Practice Address - City:CARLSTADT
Practice Address - State:NJ
Practice Address - Zip Code:07072-1016
Practice Address - Country:US
Practice Address - Phone:201-935-7833
Practice Address - Fax:201-935-3073
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00311000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ452471Medicare ID - Type Unspecified