Provider Demographics
NPI:1386986008
Name:LEONETTI, DOMENIC JOSEPH (DPM)
Entity type:Individual
Prefix:DR
First Name:DOMENIC
Middle Name:JOSEPH
Last Name:LEONETTI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 TAYLORS MILLS RD STE 111
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3281
Mailing Address - Country:US
Mailing Address - Phone:732-780-7331
Mailing Address - Fax:732-362-7840
Practice Address - Street 1:224 TAYLORS MILLS RD STE 111
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3281
Practice Address - Country:US
Practice Address - Phone:732-780-7331
Practice Address - Fax:732-362-7840
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00316200213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery