Individual
LEONARD ANTILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
GREYSTONE PARK PSYCHIATRIC HOSPITAL, 1 CENTRAL AVENUE, GREYSTONE PARK, NJ 07950
(973) 292-4070
Mailing address
80 MOUNTAIN AVE, WEST ORANGE, NJ 07052-4934
(973) 736-9189
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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