Provider Demographics
NPI:1447287511
Name:LEAL, LUIS (DPM)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:LEAL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 RIVER RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-6217
Mailing Address - Country:US
Mailing Address - Phone:201-319-0003
Mailing Address - Fax:201-313-1265
Practice Address - Street 1:7600 RIVER RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-6217
Practice Address - Country:US
Practice Address - Phone:201-319-0003
Practice Address - Fax:201-313-1265
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01709213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1664000Medicaid
NJ1664000Medicaid
NJ175130Medicare ID - Type Unspecified