Individual
LEANNA VASTOLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7600 RIVER RD, NORTH BERGEN, NJ 07047-6217
(201) 854-5000
Mailing address
12 RENE DR, MARLBORO, NJ 07746-1240
(732) 995-4290
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
022566
NY
363A00000X
Physician Assistant
Primary
25MP00484800
NJ
Other
Enumeration date
11/01/2018
Last updated
11/07/2018
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