Provider Demographics
NPI:1457302093
Name:PLEICKHARDT, ELIZABETH PATRICIA (DO)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:PATRICIA
Last Name:PLEICKHARDT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1000 HADDONFIELD BERLIN RD STE 210
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3520
Mailing Address - Country:US
Mailing Address - Phone:856-782-2212
Mailing Address - Fax:856-782-2266
Practice Address - Street 1:1 BAY AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4837
Practice Address - Country:US
Practice Address - Phone:856-782-2212
Practice Address - Fax:856-782-2266
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB084599002080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0186040Medicaid