Provider Demographics
NPI:1003812975
Name:LEFKON, BRUCE W (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:W
Last Name:LEFKON
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 1:741 NORTHFIELD AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1104
Mailing Address - Country:US
Mailing Address - Phone:973-325-6100
Mailing Address - Fax:973-325-2495
Practice Address - Street 1:741 NORTHFIELD AVE
Practice Address - Street 2:STE 206
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1104
Practice Address - Country:US
Practice Address - Phone:973-325-6100
Practice Address - Fax:973-325-2495
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA029605208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C56431Medicare UPIN
480118AYTMedicare ID - Type Unspecified