Provider Demographics
NPI:1033132493
Name:LEIBOVICI, JOSEPH S
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:LEIBOVICI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WASHINGTON ST # BLDN-51
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1740
Mailing Address - Country:US
Mailing Address - Phone:781-871-1677
Mailing Address - Fax:781-982-4094
Practice Address - Street 1:80 WASHINGTON ST # BLDN-51
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1740
Practice Address - Country:US
Practice Address - Phone:781-871-1677
Practice Address - Fax:781-982-4094
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA199501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU71618Medicare UPIN