Provider Demographics
NPI:1578373999
Name:LEAFWELL PROVIDERS NJ, P.C.
Entity type:Organization
Organization Name:LEAFWELL PROVIDERS NJ, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-458-4481
Mailing Address - Street 1:3300 BEE CAVES RD STE 6501105
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6600
Mailing Address - Country:US
Mailing Address - Phone:800-660-9085
Mailing Address - Fax:
Practice Address - Street 1:111 WESTLAKE DR
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5301
Practice Address - Country:US
Practice Address - Phone:504-458-4481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service