Provider Demographics
NPI:1275544132
Name:LIEBSON, RITA (DPM)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:
Last Name:LIEBSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HILL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5535
Mailing Address - Country:US
Mailing Address - Phone:908-787-6607
Mailing Address - Fax:
Practice Address - Street 1:6 HILL HOLLOW RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5535
Practice Address - Country:US
Practice Address - Phone:908-787-6607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00208500213E00000X
NYN004114-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5061903Medicaid
NJ696267Medicare ID - Type Unspecified
NJT51333Medicare UPIN