Provider Demographics
NPI:1457036428
Name:BANKS, LEAH SAMANTHA
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:SAMANTHA
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-3537
Mailing Address - Country:US
Mailing Address - Phone:609-969-0590
Mailing Address - Fax:
Practice Address - Street 1:1033 US HIGHWAY 46 STE 102
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2448
Practice Address - Country:US
Practice Address - Phone:973-779-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14850700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ14850700OtherLICENSE # APN; NJ BOARD OF NURSING