Provider Demographics
NPI:1861162695
Name:LEISER, ABRAHAM D (NP)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:D
Last Name:LEISER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DOOLIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1345
Mailing Address - Country:US
Mailing Address - Phone:347-201-2747
Mailing Address - Fax:
Practice Address - Street 1:187 ENCLAVE BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5787
Practice Address - Country:US
Practice Address - Phone:347-201-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348446363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner