Provider Demographics
NPI:1447263744
Name:LEU, DIANA S (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:S
Last Name:LEU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:S
Other - Last Name:LAKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA079226207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology