Provider Demographics
NPI:1821133992
Name:MEYER-GRIMES, LESLIE (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MEYER-GRIMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 BRASS CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07863-3143
Mailing Address - Country:US
Mailing Address - Phone:908-453-3383
Mailing Address - Fax:908-453-3384
Practice Address - Street 1:259 BRASS CASTLE RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NJ
Practice Address - Zip Code:07863-3143
Practice Address - Country:US
Practice Address - Phone:908-453-3383
Practice Address - Fax:908-453-3384
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03832500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C75542Medicare UPIN
002868Medicare ID - Type Unspecified