Basic Information
| Provider Information | |||||||||
| NPI: | 1821356411 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELSON-LANE | ||||||||
| FirstName: | LEIGH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 HILLVIEW AVENUE | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329403730 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 ROBERT WOOD JOHNSON PLACE | ||||||||
| Address2: | |||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322120051 | ||||||||
| FaxNumber: | 7322120713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2012 | ||||||||
| LastUpdateDate: | 08/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 25MA09079700 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0296368 | 05 | NJ | MEDICAID |