Provider Demographics
NPI:1144327123
Name:LEBER, SANDRA LYNN (DO)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:LEBER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 EGG HARBOR RD
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2359
Mailing Address - Country:US
Mailing Address - Phone:856-218-8300
Mailing Address - Fax:856-589-9487
Practice Address - Street 1:570 EGG HARBOR RD
Practice Address - Street 2:SUITE C-2
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2359
Practice Address - Country:US
Practice Address - Phone:856-218-8300
Practice Address - Fax:856-589-9487
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06253200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7868600Medicaid
NJ024193AEEMedicare PIN
NJ7868600Medicaid