Provider Demographics
NPI:1639702921
Name:JANET E. LEICHT DPM
Entity Type:Organization
Organization Name:JANET E. LEICHT DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:LEICHT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-381-8160
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:07920-2987
Mailing Address - Country:US
Mailing Address - Phone:908-625-0640
Mailing Address - Fax:908-306-9766
Practice Address - Street 1:369 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1170
Practice Address - Country:US
Practice Address - Phone:908-381-8160
Practice Address - Fax:908-306-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-15
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5061806Medicaid