1346208816 NPI number — JEFFREY DAVID LEBER DC

Table of content: JEFFREY DAVID LEBER DC (NPI 1346208816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346208816 NPI number — JEFFREY DAVID LEBER DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEBER
Provider First Name:
JEFFREY
Provider Middle Name:
DAVID
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346208816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 97
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERYVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-393-9909
Provider Business Mailing Address Fax Number:
215-393-9946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 STUMP RD
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
NORTH WALES
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-393-9909
Provider Business Practice Location Address Fax Number:
215-393-9946
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC007635L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: AJ007635L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2060659000 . This is a "IBC KEYSTONE PERSONAL CHO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 039547QNG . This is a "HGS ADMINISTRATORS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7730225 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: N68697 . This is a "AMERIHEALTH GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2671777 . This is a "OXFORD HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1368697 . This is a "HIGHMARK BLUE SHIELD GROU" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2538918 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0464475000 . This is a "IBC KEYSTONE PERSONAL CHO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 058394 . This is a "HGS ADMINISTRATORS GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 646452 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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