Provider Demographics
NPI:1497812531
Name:BRONSTEIN, LESLIE (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:BRONSTEIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 AUER CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5829
Mailing Address - Country:US
Mailing Address - Phone:732-613-6010
Mailing Address - Fax:732-238-5600
Practice Address - Street 1:7 AUER CT
Practice Address - Street 2:SUITE C
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5829
Practice Address - Country:US
Practice Address - Phone:732-613-6010
Practice Address - Fax:732-238-5600
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI 03141103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ472252Medicare ID - Type Unspecified