Provider Demographics
NPI:1720716244
Name:C LEININGEN LLC
Entity Type:Organization
Organization Name:C LEININGEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEININGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP
Authorized Official - Phone:732-740-9432
Mailing Address - Street 1:97 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-1039
Mailing Address - Country:US
Mailing Address - Phone:732-740-9432
Mailing Address - Fax:
Practice Address - Street 1:615 HOPE ROAD, BLDG 2, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724
Practice Address - Country:US
Practice Address - Phone:732-740-9432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:C LEININGEN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-11
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)