Individual
ADA BAISRE-DE LEON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
185 S ORANGE AVE, MSB C557, NEWARK, NJ 07103-2757
(973) 972-7167
Mailing address
185 S ORANGE AVE, MSB C557, NEWARK, NJ 07103-2757
(973) 972-7167
Taxonomy
Speciality
Code
Description
License number
State
207ZN0500X
Neuropathology Physician
Primary
25MA08631000
NJ
207ZP0007X
Molecular Genetic Pathology (Pathology) Physician
25MA08631000
NJ
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
25MA08631000
NJ
Other
Enumeration date
06/05/2008
Last updated
08/21/2013
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