Provider Demographics
NPI:1154322188
Name:LEIBOFF, ARNOLD ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:ROBERT
Last Name:LEIBOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 NESCONSET HIGHWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733
Mailing Address - Country:US
Mailing Address - Phone:631-689-2600
Mailing Address - Fax:631-689-2943
Practice Address - Street 1:3400 NESCONSET HIGHWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733
Practice Address - Country:US
Practice Address - Phone:631-689-2600
Practice Address - Fax:631-689-2943
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142014208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY27F472Medicare ID - Type Unspecified
NYE17722Medicare UPIN