Provider Demographics
NPI:1356641583
Name:LEBERTH, CHRISTOPHER MICHAEL II (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:LEBERTH
Suffix:II
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 PARRISH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1791
Mailing Address - Country:US
Mailing Address - Phone:585-394-1960
Mailing Address - Fax:585-393-9232
Practice Address - Street 1:229 PARRISH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1791
Practice Address - Country:US
Practice Address - Phone:585-394-1960
Practice Address - Fax:585-393-9232
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
FLPA9109191363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical