Healthcare Provider Details

I. General information

NPI: 1174648562
Provider Name (Legal Business Name): SANFORD HEIGHTS PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 SANFORD AVE
IRVINGTON NJ
07111-1444
US

IV. Provider business mailing address

987 SANFORD AVE
IRVINGTON NJ
07111-1444
US

V. Phone/Fax

Practice location:
  • Phone: 973-374-1334
  • Fax: 973-374-3082
Mailing address:
  • Phone: 973-374-1334
  • Fax: 973-374-3082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA43866
License Number StateNJ

VIII. Authorized Official

Name: DR. PIERRE R LEGER
Title or Position: OWNER
Credential: M.D.
Phone: 973-374-1334