Provider Demographics
NPI:1952546087
Name:REITZ, LEIDEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:LEIDEN
Middle Name:
Last Name:REITZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CEDAR GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3652
Mailing Address - Country:US
Mailing Address - Phone:732-688-9740
Mailing Address - Fax:
Practice Address - Street 1:40 CEDAR GROVE RD
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3652
Practice Address - Country:US
Practice Address - Phone:732-688-9740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00347100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist