Healthcare Provider Details

I. General information

NPI: 1871537746
Provider Name (Legal Business Name): RICHARD ANDREW LEICHTER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MAPLE AVE SUITE 3B COURTS OF RED BANK
RED BANK NJ
07701-1734
US

IV. Provider business mailing address

130 MAPLE AVE SUITE 3B COURTS OF RED BANK
RED BANK NJ
07701-1734
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-2111
  • Fax: 732-530-1348
Mailing address:
  • Phone: 732-747-2111
  • Fax: 732-530-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00220900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: