Provider Demographics
NPI:1689613465
Name:LIEBERMAN PARKINSON CLINIC
Entity Type:Organization
Organization Name:LIEBERMAN PARKINSON CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-403-4773
Mailing Address - Street 1:10205 COLLINS AVE
Mailing Address - Street 2:APT# 107
Mailing Address - City:BAL HARBOUR
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1403
Mailing Address - Country:US
Mailing Address - Phone:305-865-3206
Mailing Address - Fax:
Practice Address - Street 1:1440 J F KENNEDY CSWY
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-4130
Practice Address - Country:US
Practice Address - Phone:305-403-4773
Practice Address - Fax:305-403-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78796204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB80550Medicare UPIN