Provider Demographics
NPI:1508912841
Name:LIEBOWITZ, JEROME HARVEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:HARVEY
Last Name:LIEBOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 STRATTON RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-7724
Mailing Address - Country:US
Mailing Address - Phone:914-472-1756
Mailing Address - Fax:914-722-0709
Practice Address - Street 1:78 STRATTON RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-7724
Practice Address - Country:US
Practice Address - Phone:914-472-1756
Practice Address - Fax:914-722-0709
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1070112084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B01456Medicare UPIN
NY12A761Medicare ID - Type UnspecifiedMEDICARE ID