Individual
LEONARD ANTILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
25MA02133800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123456C2D
MEDICARE BILLING NO.
NJ
01
—
196546C2E
MEDICARE BILLING NO.
NJ
Enumeration date
12/15/2006
Last updated
10/14/2008
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