1215951918 NPI number — DR. MATTHEW J LIEBER DC

Table of content: DR. MATTHEW J LIEBER DC (NPI 1215951918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215951918 NPI number — DR. MATTHEW J LIEBER DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIEBER
Provider First Name:
MATTHEW
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1215951918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
677 TOMLINSON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YARDLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19067-6329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-392-5512
Provider Business Mailing Address Fax Number:
267-392-5512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 BIG OAK RD
Provider Second Line Business Practice Location Address:
124
Provider Business Practice Location Address City Name:
YARDLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19067-7801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-971-2720
Provider Business Practice Location Address Fax Number:
215-253-5333
Provider Enumeration Date:
07/26/2006

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: 111N00000X , with the licence number:  DC-006195-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: AJ-006195-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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