Provider Demographics
NPI:1609835362
Name:LIEBOWITZ, NEIL R (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:R
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 1:263 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-8082
Mailing Address - Country:US
Mailing Address - Phone:860-276-6000
Mailing Address - Fax:860-276-6059
Practice Address - Street 1:1115 WEST ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-6025
Practice Address - Country:US
Practice Address - Phone:860-276-6000
Practice Address - Fax:860-276-6059
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0257162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
P652961OtherOXFORD
CT010025716CT05OtherANTHEM BC
B83309Medicare UPIN