Healthcare Provider Details

I. General information

NPI: 1811179377
Provider Name (Legal Business Name): DOROTHY M CAJUSTE-LEGER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 PURCE ST
HILLSIDE NJ
07205-1743
US

IV. Provider business mailing address

574 PURCE ST
HILLSIDE NJ
07205-1743
US

V. Phone/Fax

Practice location:
  • Phone: 908-688-1168
  • Fax:
Mailing address:
  • Phone: 908-688-1168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: