Provider Demographics
NPI:1609989045
Name:LEISNER, WILLIAM RANDOLPH (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RANDOLPH
Last Name:LEISNER
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 1:650 TOWN BANK RD
Mailing Address - Street 2:
Mailing Address - City:N CAPE MAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08204-4409
Mailing Address - Country:US
Mailing Address - Phone:609-898-7447
Mailing Address - Fax:609-898-1912
Practice Address - Street 1:650 TOWN BANK RD
Practice Address - Street 2:
Practice Address - City:N CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-4409
Practice Address - Country:US
Practice Address - Phone:609-898-7447
Practice Address - Fax:609-898-1912
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA042301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C52740Medicare UPIN
NJLE043736Medicare ID - Type Unspecified