NPIMap

Organization Active NPI

Son Light Pediatrics PC

  • Pediatric Adolescent Medicine Physician
  • Willingboro, NJ
National Provider Identifier
1790805869
Registry record updated Nov 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
SON LIGHT PEDIATRICS PC
Practice address
621 Beverly Rancocas Rd
Suite 2D East Ridge Plaza
Willingboro, NJ 08046-3727
Phone
(609) 877-6800
NPI assigned
Mar 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Leah A Willis
Title
Practice Administrator
Phone
(609) 877-6800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X Primary

Addresses

Primary practice location

621 Beverly Rancocas Rd
Suite 2D East Ridge Plaza
Willingboro, NJ 08046-3727

Mailing address

621 Beverly Rancocas Rd
Suite 2D East Ridge Plaza
Willingboro, NJ 08046-3727
Phone (609) 877-6800

Other identifiers 1

IdentifierTypeStateIssuer
8739404MedicaidNJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320796800000",
    "number": "1790805869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 BEVERLY RANCOCAS RD",
            "address_2": "SUITE 2D EAST RIDGE PLAZA",
            "city": "WILLINGBORO",
            "state": "NJ",
            "postal_code": "080463727",
            "telephone_number": "609-877-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 BEVERLY RANCOCAS RD",
            "address_2": "SUITE 2D EAST RIDGE PLAZA",
            "city": "WILLINGBORO",
            "state": "NJ",
            "postal_code": "080463727",
            "telephone_number": "609-877-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SON LIGHT PEDIATRICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2011-11-09",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "LEAH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "609-877-6800",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8739404",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Willingboro, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.