Provider Demographics
NPI:1699729293
Name:LEEN, KEVIN LAURI (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LAURI
Last Name:LEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:65 E NORTHFIELD RD
Mailing Address - Street 2:STE L
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-992-6487
Mailing Address - Fax:973-992-7040
Practice Address - Street 1:65 E NORTHFIELD RD
Practice Address - Street 2:STE L
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-992-6487
Practice Address - Fax:973-992-7040
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA01920400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D06997Medicare UPIN
NJ458380Medicare PIN