Healthcare Provider Details

I. General information

NPI: 1851536106
Provider Name (Legal Business Name): JANET LEACH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PARK AVENUE
DUMONT NJ
07628
US

IV. Provider business mailing address

35 PIERMONT RD STE D
ROCKLEIGH NJ
07647-2702
US

V. Phone/Fax

Practice location:
  • Phone: 201-385-4400
  • Fax:
Mailing address:
  • Phone: 201-784-6490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26N008810900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: