Provider Demographics
NPI:1962475285
Name:LEEDS, RICHARD S (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:LEEDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 JACKSON STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3060
Mailing Address - Country:US
Mailing Address - Phone:908-526-8668
Mailing Address - Fax:908-231-6781
Practice Address - Street 1:225 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3060
Practice Address - Country:US
Practice Address - Phone:908-526-8668
Practice Address - Fax:908-231-6781
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA49335207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0489808Medicaid
NJ0489808Medicaid
NJ540938B86Medicare PIN