1699989947 NPI number — DR JESSE LIEBMAN CHIROPRACTIC PHYSICIAN LLC

Table of content: (NPI 1699989947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699989947 NPI number — DR JESSE LIEBMAN CHIROPRACTIC PHYSICIAN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR JESSE LIEBMAN CHIROPRACTIC PHYSICIAN LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1699989947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 OLD MARLTON PIKE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08053-2026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-596-3000
Provider Business Mailing Address Fax Number:
856-596-7311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 OLD MARLTON PIKE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARLTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08053-2026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-596-3000
Provider Business Practice Location Address Fax Number:
856-596-7311
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LIEBMAN
Authorized Official First Name:
JESSE
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
856-596-3000

Provider Taxonomy Codes

  • Taxonomy code: 111NN1001X , with the licence number:  38MC00423400 , 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)

  • Identifier: U35059 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2116578000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2116578000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2116578000 . This is a "PA.BLUE SHIELD-PERSCHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2664713 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2705755 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com