Provider Demographics
NPI:1679868863
Name:FEIBUSCH, LEAH (SE)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:FEIBUSCH
Suffix:
Gender:F
Credentials:SE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4864
Mailing Address - Country:US
Mailing Address - Phone:732-367-0213
Mailing Address - Fax:
Practice Address - Street 1:406 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4864
Practice Address - Country:US
Practice Address - Phone:732-367-0213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist