Provider Demographics
NPI:1942916416
Name:LEEDER, KEN CHARLES
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:CHARLES
Last Name:LEEDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MERLIN DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-3032
Mailing Address - Country:US
Mailing Address - Phone:201-259-1327
Mailing Address - Fax:
Practice Address - Street 1:3 MERLIN DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-3032
Practice Address - Country:US
Practice Address - Phone:201-259-1327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty