Provider Demographics
NPI:1154314813
Name:LIEBERMAN, RUTH LEONORE (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:LEONORE
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PINNACLE PL
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3496
Mailing Address - Country:US
Mailing Address - Phone:518-262-5735
Mailing Address - Fax:518-262-5743
Practice Address - Street 1:1 PINNACLE PL
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3496
Practice Address - Country:US
Practice Address - Phone:518-262-5735
Practice Address - Fax:518-262-5743
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113976-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00787504Medicaid
NYD47336Medicare UPIN
NY00787504Medicaid