Provider Demographics
NPI:1447284559
Name:CEBULA, LEONARD A (APRN)
Entity type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:A
Last Name:CEBULA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MARSHA DR
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-5400
Mailing Address - Country:US
Mailing Address - Phone:856-824-0325
Mailing Address - Fax:
Practice Address - Street 1:309 BRIDGEBORO RD
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1499
Practice Address - Country:US
Practice Address - Phone:856-439-2069
Practice Address - Fax:856-439-2078
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00004400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P96184Medicare UPIN
NJ072313WPNMedicare PIN
NJ072313Medicare PIN