Provider Demographics
NPI:1669478483
Name:CAUVIN, LESLIE RICHARD (DO)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:RICHARD
Last Name:CAUVIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 W COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2267
Mailing Address - Country:US
Mailing Address - Phone:732-942-4455
Mailing Address - Fax:
Practice Address - Street 1:400 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4509
Practice Address - Country:US
Practice Address - Phone:732-901-6400
Practice Address - Fax:732-901-0744
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06672100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7690207Medicaid
NJ008840Medicare ID - Type Unspecified
NJG68061Medicare UPIN
NJ7690207Medicaid