Provider Demographics
NPI:1144383712
Name:LIEBHABER, PAUL (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:LIEBHABER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 MINEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2001
Mailing Address - Country:US
Mailing Address - Phone:516-484-0515
Mailing Address - Fax:516-625-4546
Practice Address - Street 1:63 MINEOLA AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2001
Practice Address - Country:US
Practice Address - Phone:516-484-0515
Practice Address - Fax:516-625-4546
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4913174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ52602Medicare PIN
NYQ52602Medicare ID - Type Unspecified