Basic Information
| Provider Information | |||||||||
| NPI: | 1982932067 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENEGUZZO | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | DIANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 MAIN ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | AVON BY THE SEA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077171051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327769790 | ||||||||
| FaxNumber: | 7327769793 | ||||||||
| Practice Location | |||||||||
| Address1: | 43 MAIN ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | AVON BY THE SEA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077171051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327769790 | ||||||||
| FaxNumber: | 7327769793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2009 | ||||||||
| LastUpdateDate: | 01/09/2014 | ||||||||
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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 | 367A00000X | 4704227505 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.