1225259146 NPI number — ALICE R LEBER APRN

Table of content: ALICE R LEBER APRN (NPI 1225259146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225259146 NPI number — ALICE R LEBER APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEBER
Provider First Name:
ALICE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225259146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 CHESTNUT TREE HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06478-1173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-881-0501
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 MAIN ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06488-4237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-262-1911
Provider Business Practice Location Address Fax Number:
203-262-9434
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WE0003X , with the licence number:  VP005288B , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 003710 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500018096 . This is a "RR MEDICARE #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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