Provider Demographics
NPI:1407933450
Name:LIEF-DIENSTAG, DEBORAH J (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:LIEF-DIENSTAG
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 1:379 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1805
Mailing Address - Country:US
Mailing Address - Phone:516-569-4768
Mailing Address - Fax:516-569-4180
Practice Address - Street 1:379 BROADWAY
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1805
Practice Address - Country:US
Practice Address - Phone:516-569-4768
Practice Address - Fax:516-569-4180
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149083208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD47716Medicare UPIN