Provider Demographics
NPI:1811317431
Name:ISLEIB, ANDREW S (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:ISLEIB
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 1:101 E LANCASTER AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3544
Mailing Address - Country:US
Mailing Address - Phone:917-647-9632
Mailing Address - Fax:
Practice Address - Street 1:101 E LANCASTER AVE STE 306
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3544
Practice Address - Country:US
Practice Address - Phone:917-647-9632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018452208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation