Provider Demographics
NPI:1790328318
Name:LEIKEN, JASON
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:LEIKEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 BOILING SPRINGS AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1431
Mailing Address - Country:US
Mailing Address - Phone:201-693-1741
Mailing Address - Fax:
Practice Address - Street 1:336 W PASSAIC ST
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3027
Practice Address - Country:US
Practice Address - Phone:201-549-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-27
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst