Provider Demographics
NPI:1922020411
Name:LEICHTER, MARK FREDRIC (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:FREDRIC
Last Name:LEICHTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 FRANKLIN AVE
Mailing Address - Street 2:STE 250
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1306
Mailing Address - Country:US
Mailing Address - Phone:845-826-0150
Mailing Address - Fax:845-510-3038
Practice Address - Street 1:11 HOLT DR
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-1919
Practice Address - Country:US
Practice Address - Phone:844-777-0910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00538800111N00000X
NYX007465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX68332Medicare ID - Type Unspecified
NYU52877Medicare UPIN
NJ092082Medicare ID - Type Unspecified