Provider Demographics
NPI:1851363485
Name:MADRAK, LESLIE N (DO)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:N
Last Name:MADRAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 ROUTE 168
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-3233
Mailing Address - Country:US
Mailing Address - Phone:856-857-6920
Mailing Address - Fax:856-429-3826
Practice Address - Street 1:900 ROUTE 168
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-3233
Practice Address - Country:US
Practice Address - Phone:856-857-6920
Practice Address - Fax:856-429-3826
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB068342002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8526109Medicaid
NJ8526109Medicaid
NJH39503Medicare UPIN