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Organization
SON LIGHT PEDIATRICS PC
Active
Organization
SON LIGHT PEDIATRICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LEAH A WILLIS (PRACTICE ADMINISTRATOR)
(609) 877-6800
Entity
Organization
Contact information
Practice address
621 BEVERLY RANCOCAS RD, SUITE 2D EAST RIDGE PLAZA, WILLINGBORO, NJ 08046-3727
(609) 877-6800
Mailing address
621 BEVERLY RANCOCAS RD, SUITE 2D EAST RIDGE PLAZA, WILLINGBORO, NJ 08046-3727
(609) 877-6800
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8739404
—
NJ
Enumeration date
03/30/2007
Last updated
11/09/2011
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