Provider Demographics
NPI:1649277112
Name:TAUB, LESLIE-FAITH MORRITT (ANP-C, GNP-BC)
Entity type:Individual
Prefix:DR
First Name:LESLIE-FAITH
Middle Name:MORRITT
Last Name:TAUB
Suffix:
Gender:F
Credentials:ANP-C, GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BRUNSWICK ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6017
Mailing Address - Country:US
Mailing Address - Phone:718-761-8752
Mailing Address - Fax:718-761-8752
Practice Address - Street 1:345 E 24TH ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4020
Practice Address - Country:US
Practice Address - Phone:121-299-8942
Practice Address - Fax:121-299-5314
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN084683363LA2200X, 363LG0600X
NYF 302456-1363LA2200X
NYF340387-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01910067Medicaid
NY01910067Medicaid