Provider Demographics
NPI:1629396411
Name:LM LIEGNER MD PC
Entity Type:Organization
Organization Name:LM LIEGNER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:LIEGNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-487-7249
Mailing Address - Street 1:21 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1931
Mailing Address - Country:US
Mailing Address - Phone:516-487-3210
Mailing Address - Fax:516-487-1526
Practice Address - Street 1:21 CEDAR DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1931
Practice Address - Country:US
Practice Address - Phone:516-487-3210
Practice Address - Fax:516-487-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0433781102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB15254Medicare UPIN