Provider Demographics
NPI:1730280314
Name:LIEGNER, JEFFREY TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TODD
Last Name:LIEGNER
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 1:350 SPARTA AVE BLDG A
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871
Mailing Address - Country:US
Mailing Address - Phone:973-729-5757
Mailing Address - Fax:973-729-8322
Practice Address - Street 1:350 SPARTA AVE
Practice Address - Street 2:BLDG A
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871
Practice Address - Country:US
Practice Address - Phone:973-729-5757
Practice Address - Fax:973-729-8322
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06536300207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ906425Medicare PIN
PA906426Medicare ID - Type Unspecified
PA906426M1AMedicare PIN
NJ906425NU3Medicare PIN
E68879Medicare UPIN
PA906426Medicare PIN
NJ906425Medicare ID - Type Unspecified