Provider Demographics
NPI:1972628295
Name:LIEBERMAN, EDWARD JOSHUA (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOSHUA
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-1009
Mailing Address - Country:US
Mailing Address - Phone:914-232-0680
Mailing Address - Fax:
Practice Address - Street 1:509 MADISON AVE
Practice Address - Street 2:SUITE 1712
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5501
Practice Address - Country:US
Practice Address - Phone:212-759-4486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0333521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice