Provider Demographics
NPI:1841246394
Name:NICOSIA, LEONARD T (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:T
Last Name:NICOSIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 RATZER RD
Mailing Address - Street 2:STE.#7
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7702
Mailing Address - Country:US
Mailing Address - Phone:973-694-2222
Mailing Address - Fax:973-694-7664
Practice Address - Street 1:330 RATZER RD
Practice Address - Street 2:STE.#7
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7702
Practice Address - Country:US
Practice Address - Phone:973-694-2222
Practice Address - Fax:973-694-7664
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03341200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP383924OtherOXFORD
NJ1559206Medicaid
NJ0K2677OtherHEALTHNET
NJ0097526000OtherAMERIHEALTH
NJP383924OtherOXFORD
NJC60499Medicare UPIN