# MAHWAH MEDICAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366612178
- **Authorized official:** DR. GLENN R LESLIE DO (PRESIDENT)
- **Authorized official phone:** (201) 529-0033

## Contact information

- **Practice address:** 10 FRANKLIN TPKE, MAHWAH, NJ 07430-1304
- **Practice address phone:** (201) 529-0033
- **Practice address fax:** (201) 529-5913
- **Mailing address:** 10 FRANKLIN TPKE, MAHWAH, NJ 07430-1304
- **Mailing address phone:** (201) 529-0033
- **Mailing address fax:** (201) 529-5913

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | MB42681 | NJ | Yes |

## Other

- **Enumeration date:** 03/07/2008
- **Last updated:** 09/09/2009