Provider Demographics
NPI:1972987337
Name:SKIDMORE, LEAH (NP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:SKIDMORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:690 N BROADWAY
Mailing Address - Street 2:GL1
Mailing Address - City:N WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-2417
Mailing Address - Country:US
Mailing Address - Phone:914-428-3651
Mailing Address - Fax:914-428-2948
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1997
Practice Address - Country:US
Practice Address - Phone:201-343-6676
Practice Address - Fax:201-343-6689
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00573600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner