MEDICARE: DR. WILLIAM RANDOLPH LEISNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MA042301	NJ

General Provider Information

NPI Number	:	1609989045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM RANDOLPH LEISNER MD

Provider Business Mailing Address
First Line	:	650 TOWN BANK RD
Second Line	:
City	:	N CAPE MAY
State	:	NJ
Zip	:	08204-4409
Country	:	US
Telephone Number	:	609-898-7447
Fax Number	:	609-898-1912

Provider Business Practice Location Address
First Line	:	650 TOWN BANK RD
Second Line	:
City	:	N CAPE MAY
State	:	NJ
Zip	:	08204-4409
Country	:	US
Telephone Number	:	609-898-7447
Fax Number	:	609-898-1912

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	03/19/2014

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