Provider Demographics
NPI:1427325620
Name:DIANA S. LEU, MD, LLC
Entity type:Organization
Organization Name:DIANA S. LEU, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-925-7077
Mailing Address - Street 1:330 RATZER RD STE D17
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7704
Mailing Address - Country:US
Mailing Address - Phone:973-925-7077
Mailing Address - Fax:973-925-7078
Practice Address - Street 1:330 RATZER RD STE D17
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7704
Practice Address - Country:US
Practice Address - Phone:973-925-7077
Practice Address - Fax:973-925-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07922600261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty