Provider Demographics
NPI:1508142316
Name:PETER S. LIEBERT MD
Entity Type:Organization
Organization Name:PETER S. LIEBERT MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-428-3533
Mailing Address - Street 1:222 WESTCHESTER AVENUE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604
Mailing Address - Country:US
Mailing Address - Phone:914-428-3533
Mailing Address - Fax:914-946-8766
Practice Address - Street 1:222 WESTCHESTER AVENUE
Practice Address - Street 2:SUITE 403
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604
Practice Address - Country:US
Practice Address - Phone:914-428-3533
Practice Address - Fax:914-946-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0935752086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
52A061OtherBCBS
WS245OtherOXFORD
NY00607570Medicaid
4267440OtherAETNA US HEALTHCARE
52A061OtherBCBS
CT128591Medicare UPIN