Individual
MR. ROTH LEON RILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
23-08 MAPLE AVE, FAIR LAWN, NJ 07410
(201) 794-4500
(229) 271-3839
Mailing address
23-08 MAPLE AVE, FAIR LAWN, NJ 07410
(201) 794-4500
(229) 271-3839
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
025656
GA
207Q00000X
Family Medicine Physician
25MA09551100
NJ
207Q00000X
Family Medicine Physician
GA025656
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000280486B
—
GA
05
—
00280486B
—
GA
01
—
GA025656
GA LICENSE
GA
Enumeration date
01/17/2007
Last updated
09/17/2014
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