Provider Demographics
NPI:1548200132
Name:LEEK, EILEEN (MSN, APRN, BC)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:LEEK
Suffix:
Gender:F
Credentials:MSN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-0729
Mailing Address - Country:US
Mailing Address - Phone:201-332-3354
Mailing Address - Fax:201-536-9047
Practice Address - Street 1:196 JEWETT AVENUE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1804
Practice Address - Country:US
Practice Address - Phone:201-332-3354
Practice Address - Fax:201-536-9047
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN0499500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0100871Medicaid
NJ0100871Medicaid
NJQ62727Medicare UPIN