Healthcare Provider Details

I. General information

NPI: 1073580262
Provider Name (Legal Business Name): GEORGE LEIPSNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 W PLEASANT AVE
MAYWOOD NJ
07607-1334
US

IV. Provider business mailing address

57 W PLEASANT AVE
MAYWOOD NJ
07607-1334
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-2111
  • Fax: 201-845-5033
Mailing address:
  • Phone: 201-488-2111
  • Fax: 201-845-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA02263900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: