Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 265720 | NY |
Y | 207Q00000X | Family Doctor | 265720 | NY |
N | 207Q00000X | Family Doctor | DO2422 | ME |
NPI | 1366736902 |
---|---|
Provider Name | Dr. John Robert Leuenberger |
First Address | Lyons Falls, NY 13368-0247 |
Second Address | Lyons Falls, NY 13368 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2011 |
Last Update Date | 22/06/2021 |