Provider Demographics
NPI:1487638995
Name:MARCKS, LESLIE K (PT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:K
Last Name:MARCKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:K
Other - Last Name:MARCKS-OCHNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:106 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-8532
Mailing Address - Country:US
Mailing Address - Phone:732-785-0040
Mailing Address - Fax:732-785-0265
Practice Address - Street 1:180 TICES LN
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1345
Practice Address - Country:US
Practice Address - Phone:908-962-7689
Practice Address - Fax:732-785-0265
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00399600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ078741Medicare PIN
Q15051Medicare UPIN