Provider Demographics
NPI:1407036650
Name:HERMAN, LESLIE ELIZABETH (AUD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ELIZABETH
Last Name:HERMAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3614
Mailing Address - Country:US
Mailing Address - Phone:908-277-6886
Mailing Address - Fax:908-277-3478
Practice Address - Street 1:75 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3614
Practice Address - Country:US
Practice Address - Phone:908-277-6886
Practice Address - Fax:908-277-3478
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYA00102237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0031631Medicaid
NJ3177700Medicaid
640004622OtherRAILROAD MEDICARE
NJ0031631Medicaid
NJ205803XZWMedicare PIN