Provider Demographics
NPI:1942639497
Name:GLEIBERMAN, SHANI (MSED)
Entity Type:Individual
Prefix:
First Name:SHANI
Middle Name:
Last Name:GLEIBERMAN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MONSEY HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3517
Mailing Address - Country:US
Mailing Address - Phone:845-425-0504
Mailing Address - Fax:
Practice Address - Street 1:19 MONSEY HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-3517
Practice Address - Country:US
Practice Address - Phone:845-425-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1140978174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist