Provider Demographics
NPI:1609194075
Name:LEESE-SHINSKE, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:LEESE-SHINSKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SASSAFRAS WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8131
Mailing Address - Country:US
Mailing Address - Phone:609-206-1127
Mailing Address - Fax:
Practice Address - Street 1:1 BRITTON PL
Practice Address - Street 2:SUITE 12
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2514
Practice Address - Country:US
Practice Address - Phone:856-772-1880
Practice Address - Fax:856-770-0718
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09422400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine