Provider Demographics
NPI:1396844163
Name:LIEBER, COLETTE D (MD)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:D
Last Name:LIEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FRANKLIN TURNPIKE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430
Mailing Address - Country:US
Mailing Address - Phone:201-825-0009
Mailing Address - Fax:201-825-2622
Practice Address - Street 1:400 FRANKLIN TPK
Practice Address - Street 2:SUITE 208
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430
Practice Address - Country:US
Practice Address - Phone:201-825-0009
Practice Address - Fax:201-825-2622
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2010-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ51951207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A60399Medicare UPIN
572535Medicare ID - Type Unspecified