Provider Demographics
NPI:1366736902
Name:LEUENBERGER, JOHN ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:LEUENBERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:LYONS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13368-0247
Mailing Address - Country:US
Mailing Address - Phone:315-348-8407
Mailing Address - Fax:315-348-4162
Practice Address - Street 1:3926 STATE ROUTE 12
Practice Address - Street 2:
Practice Address - City:LYONS FALLS
Practice Address - State:NY
Practice Address - Zip Code:13368
Practice Address - Country:US
Practice Address - Phone:315-348-8407
Practice Address - Fax:315-348-4162
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265720204D00000X, 207Q00000X
MEDO2422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM