Healthcare Provider Details

I. General information

NPI: 1982282877
Provider Name (Legal Business Name): ROBERT FULTON LEGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 EASTCHESTER RD
BRONX NY
10461-2301
US

IV. Provider business mailing address

1825 EASTCHESTER RD
BRONX NY
10461-2301
US

V. Phone/Fax

Practice location:
  • Phone: 412-352-0536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number336469
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: