Leah Martin, PA-C
Individual provider Active NPI Physician Assistant · Lakewood, NJ
NPI 1710490487 · NPPES record last updated Nov 24, 2020
Key facts
- NPI
- 1710490487
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 021636 (NY)
- Practice address
- 120 Glen Ave Apt a
Lakewood, NJ 08701-3059 - Phone
- (845) 502-2464
- NPI assigned
- Nov 15, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lakewood Resource and Referral Center Inc
Practice addresses (Care Compare)
1771 Madison Ave
Lakewood, NJ 08701-1242
Phone (732) 364-2144
1771 Madison Ave
Lakewood, NJ 08701-1251
Hospital & facility affiliations
- Monmouth Medical Center-Southern Campus
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210120003121 | NJ | Practitioner - Physician Assistant | 3274897970 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021636 | NY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakewood Resource and Referral Center, Inc. | Current |
Accepting new patients | |
| Lakewood Resource and Referral Center, Inc. | Current |
Accepting new patients | |
| Lakewood Resource and Referral Center Inc | Past | Accepting new patients |
Locations
1771 Madison Ave
#9
Lakewood, NJ 08701
1771 Madison Ave
Lakewood, NJ 08701
Phone (732) 364-2144
Interoperability endpoints
- leah.martin@chemed.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Physician Assistant | 363A00000X | 021636 | NY | Yes |
Addresses
Primary practice location
120 Glen Ave Apt a
Lakewood, NJ 08701-3059
Mailing address
120 Glen Ave Apt a
Lakewood, NJ 08701-3059
Other practice location 1
12 Patricia Ln
Spring Valley, NY 10977-1601
Phone (845) 548-9609
Other providers in Lakewood, NJ
- Edward M Maron
- Marquis Therapy of NJ LLC
- Susanne Mars
- Alicia Ann Marshall
- James Joseph Martin
- Deicy Martinez-Fam
- Jennifer Martinez
- Denise M Martino
- Maruti Medical, LLC
- Rivka R Marx Rottenberg
All providers in Lakewood, NJ · Physician Assistant in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 24, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.