Provider Demographics
NPI:1366485781
Name:LEITMAN, MARK W (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:LEITMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13 BRUNSWICK WOODS DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5601
Mailing Address - Country:US
Mailing Address - Phone:732-254-9090
Mailing Address - Fax:732-254-4704
Practice Address - Street 1:13 BRUNSWICK WOODS DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5601
Practice Address - Country:US
Practice Address - Phone:732-254-9090
Practice Address - Fax:732-254-4704
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA02993800207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2881209Medicaid
NJLE117449Medicare ID - Type Unspecified
NJ2881209Medicaid