Provider Demographics
NPI:1881689495
Name:LEQUERICA, STEVE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:
Last Name:LEQUERICA
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 1:905 ALLWOOD RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1945
Mailing Address - Country:US
Mailing Address - Phone:973-471-3680
Mailing Address - Fax:973-471-6360
Practice Address - Street 1:905 ALLWOOD RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1945
Practice Address - Country:US
Practice Address - Phone:973-471-3680
Practice Address - Fax:973-471-6360
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA046068002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0100004850OtherAMERICHOICE
NJ0357901Medicaid
4516374OtherAETNA
OK1390OtherHEALTHNET
130005561OtherRAILROAD MEDICARE
NJ10780OtherAMERIGROUP
NJ1340273OtherUNITED HEALTHCARE
PS225OtherOXFORD
C60368Medicare UPIN
130005561OtherRAILROAD MEDICARE