Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | MA45946 | NJ |
NPI | 1982606471 |
---|---|
Provider Name | Dr. Kerry S Lebenger |
First Address | Berkeley Heights, NJ 07922-2104 |
Second Address | Berkeley Heights, NJ 07922-2104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 05/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E54383 | (02) | NJ |