Individual
DR. GLENN R LESLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
10 FRANKLIN TPKE, MAHWAH, NJ 07430-1304
(201) 529-0033
(201) 529-5913
Mailing address
10 FRANKLIN TPKE, MAHWAH MEDICAL, MAHWAH, NJ 07430
(201) 529-3380
(201) 529-5913
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MB42681
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0K6749
HEALTHNET INS ID
NJ
01
—
222790526
TAX ID
NJ
01
—
223636986
TAX ID AS OF 01/01/12
NJ
01
—
BP329
OXFORD INS PLAN
NJ
Enumeration date
11/01/2006
Last updated
11/08/2012
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