Provider Demographics
NPI:1164256384
Name:LAUFER, LESLIE JEAN (LMT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:JEAN
Last Name:LAUFER
Suffix:
Gender:X
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MOHICAN PL
Mailing Address - Street 2:
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034-2812
Mailing Address - Country:US
Mailing Address - Phone:646-427-8586
Mailing Address - Fax:
Practice Address - Street 1:125 MADISON ST
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-2153
Practice Address - Country:US
Practice Address - Phone:973-299-2430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01379600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist