Provider Demographics
NPI:1457326035
Name:LEICHT, JANET (DPM)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:LEICHT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GREEN MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920
Mailing Address - Country:US
Mailing Address - Phone:908-306-9767
Mailing Address - Fax:908-306-9766
Practice Address - Street 1:1811 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1041
Practice Address - Country:US
Practice Address - Phone:908-665-0010
Practice Address - Fax:908-306-9766
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD001969213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5061806Medicaid
NJ5061806Medicaid
U16857Medicare UPIN