NPIMap

Organization Active NPI

Mahwah Medical

  • Internal Medicine Physician
  • Mahwah, NJ
National Provider Identifier
1366612178
Registry record updated Sep 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MB42681 Issued in NJ
Legal business name
MAHWAH MEDICAL
Practice address
10 Franklin Tpke
Mahwah, NJ 07430-1304
Phone
(201) 529-0033
Fax
(201) 529-5913
NPI assigned
Mar 7, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Glenn R Leslie, DO
Title
President
Phone
(201) 529-0033

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X MB42681 NJ Primary

Addresses

Primary practice location

10 Franklin Tpke
Mahwah, NJ 07430-1304

Mailing address

10 Franklin Tpke
Mahwah, NJ 07430-1304
Phone (201) 529-0033

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252454400000",
    "number": "1366612178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 FRANKLIN TPKE",
            "city": "MAHWAH",
            "state": "NJ",
            "postal_code": "074301304",
            "telephone_number": "201-529-0033",
            "fax_number": "201-529-5913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 FRANKLIN TPKE",
            "city": "MAHWAH",
            "state": "NJ",
            "postal_code": "074301304",
            "telephone_number": "201-529-0033",
            "fax_number": "201-529-5913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAHWAH MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-07",
        "last_updated": "2009-09-09",
        "status": "A",
        "authorized_official_last_name": "LESLIE",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-529-0033",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MB42681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mahwah, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.