Provider Demographics
NPI:1407815947
Name:HUPPERT, LEON J (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:J
Last Name:HUPPERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:101 PROSPECT STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:732-367-0699
Mailing Address - Fax:732-367-0937
Practice Address - Street 1:101 PROSPECT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:732-367-0699
Practice Address - Fax:732-367-0937
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03468500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2930005Medicaid
NJ4093839OtherAETNA
NJ22225141OtherHORIZON
NJP407030OtherOXFORD
NJ0K8110OtherHEALTH NET
C57503Medicare UPIN
NJ131626Medicare PIN
NJ305436Medicare PIN