Provider Demographics
NPI:1871506576
Name:KUKLA, LEON FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:FRANCIS
Last Name:KUKLA
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 1:817 INMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1361
Mailing Address - Country:US
Mailing Address - Phone:732-381-8600
Mailing Address - Fax:732-381-8960
Practice Address - Street 1:817 INMAN AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1361
Practice Address - Country:US
Practice Address - Phone:732-381-8600
Practice Address - Fax:732-381-8960
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA02159000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
C0364Medicare UPIN