Provider Demographics
NPI:1447378575
Name:EQUINOX FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:EQUINOX FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARA
Authorized Official - Middle Name:V
Authorized Official - Last Name:LIEBLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-362-1121
Mailing Address - Street 1:PO BOX 50
Mailing Address - Street 2:3869 MAIN ST.
Mailing Address - City:MANCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05254-0050
Mailing Address - Country:US
Mailing Address - Phone:802-362-1121
Mailing Address - Fax:802-362-9121
Practice Address - Street 1:3869 MAIN ST.
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05254
Practice Address - Country:US
Practice Address - Phone:802-362-1121
Practice Address - Fax:802-362-9121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty