Provider Demographics
NPI:1639333990
Name:HAIN, LESLIE JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JEAN
Last Name:HAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:JEAN
Other - Last Name:LEDERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15 ALDO DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-1735
Mailing Address - Country:US
Mailing Address - Phone:203-389-5995
Mailing Address - Fax:203-389-5995
Practice Address - Street 1:15 ALDO DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-1735
Practice Address - Country:US
Practice Address - Phone:203-389-5995
Practice Address - Fax:203-389-5995
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043957207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine