1497782775 NPI number — DR. CATHERINE A LIEBHAUSER M.D.

Table of content: DR. CATHERINE A LIEBHAUSER M.D. (NPI 1497782775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497782775 NPI number — DR. CATHERINE A LIEBHAUSER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIEBHAUSER
Provider First Name:
CATHERINE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1497782775
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 CRESTMONT RD APT 6R
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTCLAIR
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07042-1936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-746-7712
Provider Business Mailing Address Fax Number:
12-465-4610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 PORTLAND PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTCLAIR
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07042-2822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-746-7712
Provider Business Practice Location Address Fax Number:
201-462-3847
Provider Enumeration Date:
06/26/2006

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: 2084P0800X , with the licence number:  25MA05676000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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