Provider Demographics
NPI:1306081716
Name:MALIBIRAN, LEILANI (RPT)
Entity type:Individual
Prefix:
First Name:LEILANI
Middle Name:
Last Name:MALIBIRAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 AYCRIGG AVE APT 8E
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3725
Mailing Address - Country:US
Mailing Address - Phone:201-388-6762
Mailing Address - Fax:
Practice Address - Street 1:11 W 25TH ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3800
Practice Address - Country:US
Practice Address - Phone:201-243-9291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPTQA01102400111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation