Provider Demographics
NPI:1659687903
Name:LEONID LAMPER MD PC
Entity Type:Organization
Organization Name:LEONID LAMPER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-871-2127
Mailing Address - Street 1:PO BOX 986520
Mailing Address - Street 2:DEPARTMENT 400
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02298-6520
Mailing Address - Country:US
Mailing Address - Phone:207-784-2554
Mailing Address - Fax:207-777-1439
Practice Address - Street 1:619 RIVER DR
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407
Practice Address - Country:US
Practice Address - Phone:704-871-2127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0535834Medicaid
NJ168330OtherMEDICARE PTAN