Provider Demographics
NPI:1891720827
Name:KEVIN L LEEN MD E ALLAN SPEIDELL MD ASSOC IN INTERNAL MED PC
Entity Type:Organization
Organization Name:KEVIN L LEEN MD E ALLAN SPEIDELL MD ASSOC IN INTERNAL MED PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LAURI
Authorized Official - Last Name:LEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-992-6487
Mailing Address - Street 1:65 EAST NORTHFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-992-6487
Mailing Address - Fax:973-992-7040
Practice Address - Street 1:65 EAST NORTHFIELD ROAD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-992-6487
Practice Address - Fax:973-992-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01920400207R00000X
NJ25MA01924700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ458380Medicare PIN