Provider Demographics
NPI:1740789049
Name:BERGER, LESLIE (APN)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 WEST MAIN STREET
Mailing Address - Street 2:AMBULATORY CAMPUS SUITE 100
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-294-2574
Mailing Address - Fax:732-294-2575
Practice Address - Street 1:901 WEST MAIN STREET
Practice Address - Street 2:AMBULATORY CAMPUS SUITE 100
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-294-2574
Practice Address - Fax:732-294-2575
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00771600363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4141008Medicaid