Provider Demographics
NPI:1376886499
Name:LEIBNER, EVAN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:SCOTT
Last Name:LEIBNER
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 1:1 GUSTAVE LEVY PL
Mailing Address - Street 2:BOX 1264
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-1544
Mailing Address - Country:US
Mailing Address - Phone:410-732-8867
Mailing Address - Fax:410-328-6382
Practice Address - Street 1:1 GUSTAVE LEVY PLACE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1002
Practice Address - Country:US
Practice Address - Phone:212-241-8867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYD82428207P00000X
MDD824282086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care