Provider Demographics
NPI:1205814001
Name:LEIBRANDT, PAUL N (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:N
Last Name:LEIBRANDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 S BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:MOUNT EPHRAIM
Mailing Address - State:NJ
Mailing Address - Zip Code:08059-1321
Mailing Address - Country:US
Mailing Address - Phone:856-931-3107
Mailing Address - Fax:
Practice Address - Street 1:2 S BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:MOUNT EPHRAIM
Practice Address - State:NJ
Practice Address - Zip Code:08059-1321
Practice Address - Country:US
Practice Address - Phone:856-931-3107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428225207P00000X
NJ25MA10112500207P00000X
DEC10007582207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000036192Medicaid
DE1000036192Medicaid
DE016961D04Medicare ID - Type Unspecified