1609843796 NPI number — DR. NEIL K LIEBMAN DC,C.C.S.T.

Table of content: DR. NEIL K LIEBMAN DC,C.C.S.T. (NPI 1609843796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609843796 NPI number — DR. NEIL K LIEBMAN DC,C.C.S.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIEBMAN
Provider First Name:
NEIL
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC,C.C.S.T.
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:
1609843796
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2123 BROWNING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENNSAUKEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08110-1910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-662-4455
Provider Business Mailing Address Fax Number:
856-662-5600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2123 BROWNING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENNSAUKEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08110-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-662-4455
Provider Business Practice Location Address Fax Number:
856-662-5600
Provider Enumeration Date:
03/07/2006

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:  38MC00341200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: DC003513L , 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)

  • Identifier: 6097103 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0085994000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0085994000 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6484723 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 5198122 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 22308 . This is a "AMERIGROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 878808 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1K0042 . This is a "LANDMARK" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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