Provider Demographics
NPI:1750429080
Name:LEITER, GREGORY M (PA-C)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:M
Last Name:LEITER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PLAINSBORO RD
Mailing Address - Street 2:STE 260
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-1915
Mailing Address - Country:US
Mailing Address - Phone:215-579-7728
Mailing Address - Fax:
Practice Address - Street 1:5 PLAINSBORO RD
Practice Address - Street 2:STE 260
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-1915
Practice Address - Country:US
Practice Address - Phone:215-579-7728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00215000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS99992Medicare UPIN
PA970016218OtherRAILROAD MEDICARE
PA035613JL1Medicare ID - Type Unspecified