Provider Demographics
NPI:1467626317
Name:DR. MARK D. LEODORI, D.P.M.,P.A.
Entity Type:Organization
Organization Name:DR. MARK D. LEODORI, D.P.M.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEODORI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM,PA
Authorized Official - Phone:973-790-1303
Mailing Address - Street 1:194 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2663
Mailing Address - Country:US
Mailing Address - Phone:973-790-1303
Mailing Address - Fax:973-790-5033
Practice Address - Street 1:194 UNION BLVD
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2663
Practice Address - Country:US
Practice Address - Phone:973-790-1303
Practice Address - Fax:973-790-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD1292213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1618601Medicaid
0923620001Medicare NSC
NJT44542Medicare UPIN
NJ1618601Medicaid