Provider Demographics
NPI:1407902208
Name:LEIBOWITZ, JEFFREY NEIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:NEIL
Last Name:LEIBOWITZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1453
Mailing Address - Country:US
Mailing Address - Phone:718-728-8320
Mailing Address - Fax:718-728-6493
Practice Address - Street 1:3504 31ST AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-1453
Practice Address - Country:US
Practice Address - Phone:718-728-8320
Practice Address - Fax:718-728-6493
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0411341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice