Provider Demographics
NPI:1992170369
Name:ANTOINE, LEON (LPN, RN)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:ANTOINE
Suffix:
Gender:M
Credentials:LPN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 PROSPECT ST APT 9C
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-2894
Mailing Address - Country:US
Mailing Address - Phone:973-676-1099
Mailing Address - Fax:
Practice Address - Street 1:276 PROSPECT ST APT 9C
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-2894
Practice Address - Country:US
Practice Address - Phone:973-676-1099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY67838-1163W00000X
NJ26NP06467100164W00000X
NJ26NR17952900163W00000X
NY285341-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse