Provider Demographics
NPI:1598744344
Name:LEONG, PERRY L (MD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:L
Last Name:LEONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 UNION AVE
Mailing Address - Street 2:BUILDING 1, FIRST FLOOR
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1963
Mailing Address - Country:US
Mailing Address - Phone:732-356-3212
Mailing Address - Fax:732-356-5002
Practice Address - Street 1:619 UNION AVE
Practice Address - Street 2:BUILDING 1, FIRST FLOOR
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1963
Practice Address - Country:US
Practice Address - Phone:732-356-3212
Practice Address - Fax:732-356-5002
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA061062207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223580109OtherUNITED HEALTHCARE PROVIDE
NJ539794OtherAETNA PROVIDER NUMBER
NJP377639OtherOXFORD PROVIDER ID
NJ223508109OtherHORIZON PROVIDER NUMBER
NJ6691706Medicaid
NJG19697Medicare UPIN
NJ6691706Medicaid