Provider Demographics
NPI:1487633079
Name:LIEBERGALL EYE ASSOCIATES, M.D.,P.C.
Entity Type:Organization
Organization Name:LIEBERGALL EYE ASSOCIATES, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LIEBERGALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-357-2500
Mailing Address - Street 1:222 ROUTE 59
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5204
Mailing Address - Country:US
Mailing Address - Phone:845-357-2500
Mailing Address - Fax:845-368-3937
Practice Address - Street 1:222 ROUTE 59
Practice Address - Street 2:SUITE 207
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5204
Practice Address - Country:US
Practice Address - Phone:845-357-2500
Practice Address - Fax:845-368-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096817Medicare PIN
NYWEW881Medicare PIN