1598861247 NPI number — DR. PETER SELIG LIEBERT M.D., FACS, FAAP

Table of content: DR. PETER SELIG LIEBERT M.D., FACS, FAAP (NPI 1598861247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598861247 NPI number — DR. PETER SELIG LIEBERT M.D., FACS, FAAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIEBERT
Provider First Name:
PETER
Provider Middle Name:
SELIG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., FACS, FAAP
Provider Gender Code:
M

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:
1598861247
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 WESTCHESTER AVE
Provider Second Line Business Mailing Address:
SUITE 403
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10604-2906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-428-3533
Provider Business Mailing Address Fax Number:
914-946-8766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 WESTCHESTER AVE
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10604-2906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-428-3533
Provider Business Practice Location Address Fax Number:
914-946-8766
Provider Enumeration Date:
09/16/2006

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: 2086S0120X , with the licence number:  093575 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086S0120X , with the licence number: 028589 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 093575 . This is a "NEW YORK LISCENCE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 082589 . This is a "CONN. LISCENCE #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 00607570 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".