Provider Demographics
NPI:1396810214
Name:LEIBNER, DONALD N (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:N
Last Name:LEIBNER
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 1:579A CRANBURY RD
Mailing Address - Street 2:STE 103
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5426
Mailing Address - Country:US
Mailing Address - Phone:732-390-4900
Mailing Address - Fax:732-390-4461
Practice Address - Street 1:579A CRANBURY RD
Practice Address - Street 2:STE 103
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5426
Practice Address - Country:US
Practice Address - Phone:732-390-4900
Practice Address - Fax:732-390-4461
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04270600207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLE192853Medicare ID - Type Unspecified
NJA64407Medicare UPIN