Healthcare Provider Details

I. General information

NPI: 1578535860
Provider Name (Legal Business Name): LEIGH S ENDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 STATE ROUTE 10
RANDOLPH NJ
07869-2025
US

IV. Provider business mailing address

715 STATE HIGHWAY 10
RANDOLPH NJ
07869-2025
US

V. Phone/Fax

Practice location:
  • Phone: 973-366-5565
  • Fax: 973-361-2308
Mailing address:
  • Phone: 973-366-5565
  • Fax: 973-361-2308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA037687
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: