Provider Demographics
NPI:1528169539
Name:LEYSON, JOSE FLORANTE JUSTINIANE (MD)
Entity type:Individual
Prefix:
First Name:JOSE FLORANTE
Middle Name:JUSTINIANE
Last Name:LEYSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 WESTSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304
Mailing Address - Country:US
Mailing Address - Phone:201-434-7800
Mailing Address - Fax:201-434-6715
Practice Address - Street 1:562 WESTSIDE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304
Practice Address - Country:US
Practice Address - Phone:201-434-7800
Practice Address - Fax:201-434-6715
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03698400208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6356702Medicaid
C56753Medicare UPIN
NJLE5267Medicare ID - Type Unspecified