Provider Demographics
NPI:1114999760
Name:LIEDER, JOSEPH N (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:N
Last Name:LIEDER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-2436
Mailing Address - Country:US
Mailing Address - Phone:845-356-3166
Mailing Address - Fax:845-356-3201
Practice Address - Street 1:75 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-2436
Practice Address - Country:US
Practice Address - Phone:845-356-3166
Practice Address - Fax:845-356-3201
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003566-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC26251Medicare PIN
NY00352Medicare PIN
NY0152740001Medicare NSC