Provider Demographics
NPI:1144406232
Name:M LEIBMAN OBGYN LLC
Entity Type:Organization
Organization Name:M LEIBMAN OBGYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:LEIBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-837-2100
Mailing Address - Street 1:100 STATE ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5200
Mailing Address - Country:US
Mailing Address - Phone:201-837-2100
Mailing Address - Fax:201-837-2188
Practice Address - Street 1:100 STATE ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5200
Practice Address - Country:US
Practice Address - Phone:201-837-2100
Practice Address - Fax:201-837-2188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60838207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG46587Medicare UPIN