Provider Demographics
NPI:1972563575
Name:LESHNER, STANLEY B (DO)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:B
Last Name:LESHNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 HURFFVILLE CROSS KEYS RD
Mailing Address - Street 2:SUITE A 1
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080
Mailing Address - Country:US
Mailing Address - Phone:856-589-4610
Mailing Address - Fax:856-589-1624
Practice Address - Street 1:302 HURFFVILLE CROSS KEYS RD
Practice Address - Street 2:SUITE A 1
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080
Practice Address - Country:US
Practice Address - Phone:856-589-4610
Practice Address - Fax:856-589-1624
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02759200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0699403Medicaid
E53056Medicare UPIN
NJ0699403Medicaid