Provider Demographics
NPI:1609271493
Name:LEIBU, DORA (DO)
Entity Type:Individual
Prefix:DR
First Name:DORA
Middle Name:
Last Name:LEIBU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 WERT AVE
Mailing Address - Street 2:APT. B
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-4522
Mailing Address - Country:US
Mailing Address - Phone:724-757-4591
Mailing Address - Fax:
Practice Address - Street 1:477 ROUTE 10 E
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2142
Practice Address - Country:US
Practice Address - Phone:862-260-3020
Practice Address - Fax:973-328-6869
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA016128207Q00000X
NJ25MB10154000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine