Provider Demographics
NPI:1811386741
Name:LEONARD SISKIN, P.A.
Entity Type:Organization
Organization Name:LEONARD SISKIN, P.A.
Other - Org Name:SISKIN FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SISKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-752-6606
Mailing Address - Street 1:326 US HIGHWAY 22
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-1756
Mailing Address - Country:US
Mailing Address - Phone:732-752-6606
Mailing Address - Fax:732-752-6643
Practice Address - Street 1:326 US HIGHWAY 22
Practice Address - Street 2:SUITE 6B
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-1756
Practice Address - Country:US
Practice Address - Phone:732-752-6606
Practice Address - Fax:732-752-6643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00520400225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ18KT00520400OtherNJ MASSAGE THERAPY LICENSE NUMBER