Provider Demographics
NPI:1619921749
Name:LIEB, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:LIEB
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:110 SOUTH BEDFORD ROAD
Mailing Address - Street 2:CARE MOUNT MEDICAL PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3412
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:90 S BEDFORD RD
Practice Address - Street 2:CARE MOUNT MEDICAL PC
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3412
Practice Address - Country:US
Practice Address - Phone:914-241-1050
Practice Address - Fax:914-242-1516
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2016-11-15
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Provider Licenses
StateLicense IDTaxonomies
NY180753207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01683210Medicaid
NYE76279Medicare UPIN
NY01683210Medicaid