Provider Demographics
NPI:1437315181
Name:REISBERG, LEO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:
Last Name:REISBERG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 SOMERSET ST APT 1202
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2081
Mailing Address - Country:US
Mailing Address - Phone:908-752-2117
Mailing Address - Fax:
Practice Address - Street 1:11 BISHOP PL
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1178
Practice Address - Country:US
Practice Address - Phone:848-932-7402
Practice Address - Fax:732-932-8255
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00265100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant