Provider Demographics
NPI:1386746543
Name:LEUNISSEN & LEUNISSEN P.C.
Entity type:Organization
Organization Name:LEUNISSEN & LEUNISSEN P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R. L.
Authorized Official - Middle Name:ABRAHAM
Authorized Official - Last Name:LEUNISSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-566-9122
Mailing Address - Street 1:1078 W. BALTIMORE PIKE
Mailing Address - Street 2:SUITE # 209
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5196
Mailing Address - Country:US
Mailing Address - Phone:610-566-9122
Mailing Address - Fax:610-891-7834
Practice Address - Street 1:1078 W. BALTIMORE PIKE
Practice Address - Street 2:SUITE # 209
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5196
Practice Address - Country:US
Practice Address - Phone:610-566-9122
Practice Address - Fax:610-891-7834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032215L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00935159Medicaid
PA207RC0000XOtherTAXONOMY CODE
B34588Medicare UPIN
PA00935159Medicaid