Individual
LEIDE ETIENNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
174 BAY AVE, GLEN RIDGE, NJ 07028-2404
(862) 218-8625
Mailing address
174 BAY AVE, GLEN RIDGE, NJ 07028-2404
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
269725
NY
Other
Enumeration date
12/29/2015
Last updated
12/29/2015
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