Provider Demographics
NPI:1609048644
Name:TERRY D LIEBMAN AND NADEEM T NASEEM
Entity Type:Organization
Organization Name:TERRY D LIEBMAN AND NADEEM T NASEEM
Other - Org Name:MANHATTAN AVENUE FAMILY DENTAL PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-389-4266
Mailing Address - Street 1:947 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-1623
Mailing Address - Country:US
Mailing Address - Phone:718-389-4266
Mailing Address - Fax:718-389-7259
Practice Address - Street 1:947 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-1623
Practice Address - Country:US
Practice Address - Phone:718-389-4266
Practice Address - Fax:718-389-7259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00864806Medicaid
NY02226479Medicaid