Provider Demographics
NPI:1376629014
Name:LIEBERMAN, ALAN HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:HOWARD
Last Name:LIEBERMAN
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 1:52 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-7935
Mailing Address - Country:US
Mailing Address - Phone:732-349-5200
Mailing Address - Fax:732-349-5235
Practice Address - Street 1:52 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-7935
Practice Address - Country:US
Practice Address - Phone:732-349-5200
Practice Address - Fax:732-349-5235
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03429900208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0699004Medicaid
LI417580Medicare ID - Type Unspecified
NJ0699004Medicaid