1851301139 NPI number — THEODORE W LIEBERMAN MD PC

Table of content: (NPI 1851301139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851301139 NPI number — THEODORE W LIEBERMAN MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THEODORE W LIEBERMAN MD PC
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:
1851301139
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 E 96TH ST
Provider Second Line Business Mailing Address:
1B
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10128-0747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-722-5477
Provider Business Mailing Address Fax Number:
212-722-5599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 E 96TH ST
Provider Second Line Business Practice Location Address:
1B
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10128-0747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-722-5477
Provider Business Practice Location Address Fax Number:
212-722-5599
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIEBERMAN
Authorized Official First Name:
THEODORE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT OF CORPORATION
Authorized Official Telephone Number:
212-722-5477

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  083922 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NS3039 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00125755 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5C5092 . This is a "HEALTHYNET" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com