Provider Demographics
NPI:1598861247
Name:LIEBERT, PETER SELIG (MD, FACS, FAAP)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:SELIG
Last Name:LIEBERT
Suffix:
Gender:M
Credentials:MD, FACS, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 WESTCHESTER AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2906
Mailing Address - Country:US
Mailing Address - Phone:914-428-3533
Mailing Address - Fax:914-946-8766
Practice Address - Street 1:222 WESTCHESTER AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2906
Practice Address - Country:US
Practice Address - Phone:914-428-3533
Practice Address - Fax:914-946-8766
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0935752086S0120X
CT0285892086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY093575OtherNEW YORK LISCENCE #
CT082589OtherCONN. LISCENCE #
NY00607570Medicaid
CT128591Medicare UPIN
NY093575OtherNEW YORK LISCENCE #
NYWS245OtherOXFORD
NY00607570Medicaid
52A061OtherBCBS
CT082589OtherCONN. LISCENCE #
NYB15889Medicare UPIN
CT128591Medicare UPIN