Provider Demographics
NPI:1063619054
Name:DR ANDREW T LEYBLE P C
Entity type:Organization
Organization Name:DR ANDREW T LEYBLE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEYBLE
Authorized Official - Suffix:
Authorized Official - Credentials:PC
Authorized Official - Phone:201-991-0211
Mailing Address - Street 1:312 BELLEVILLE TPKE
Mailing Address - Street 2:
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-6463
Mailing Address - Country:US
Mailing Address - Phone:201-991-0211
Mailing Address - Fax:201-997-4149
Practice Address - Street 1:312 BELLEVILLE TPKE
Practice Address - Street 2:
Practice Address - City:NORTH ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07031-6463
Practice Address - Country:US
Practice Address - Phone:201-991-0211
Practice Address - Fax:201-997-4149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00372400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty