Provider Demographics
NPI:1821356411
Name:NELSON-LANE, LEIGH (MD)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:NELSON-LANE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PINTER LN
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-3100
Mailing Address - Country:US
Mailing Address - Phone:201-953-3571
Mailing Address - Fax:
Practice Address - Street 1:750 BRUNSWICK AVENUE
Practice Address - Street 2:4TH FLOOR ANESTHESIA OFFICE
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638
Practice Address - Country:US
Practice Address - Phone:609-815-2767
Practice Address - Fax:609-815-7502
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09079700207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0296368Medicaid
NJ242952A01Medicare PIN