Provider Demographics
NPI:1821356411
Name:NELSON-LANE, LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:NELSON-LANE
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 1:40 HILLVIEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823
Mailing Address - Country:US
Mailing Address - Phone:732-940-3730
Mailing Address - Fax:
Practice Address - Street 1:1 ROBERT WOOD JOHNSON PLACE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-212-0051
Practice Address - Fax:732-212-0713
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09079700207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0296368Medicaid
NJ242952A01Medicare PIN