Individual
NICOLE LEO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4 W ROOSEVELT BLVD STE 11&12, MARMORA, NJ 08223-1441
(609) 814-9550
(609) 390-3511
Mailing address
4 W ROOSEVELT BLVD STE 11&12, MARMORA, NJ 08223-1441
(609) 390-0882
(609) 390-3511
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MB07318600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0324248
—
NJ
Enumeration date
06/05/2006
Last updated
06/19/2023
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