Provider Demographics
NPI:1982642294
Name:LEIBOWITZ, HELEN (MD)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:LEIBOWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N LANSDOWNE AVE
Mailing Address - Street 2:DCMH
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1114
Mailing Address - Country:US
Mailing Address - Phone:610-394-1735
Mailing Address - Fax:610-284-8312
Practice Address - Street 1:501 N LANSDOWNE AVE
Practice Address - Street 2:DCMH
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1114
Practice Address - Country:US
Practice Address - Phone:610-394-1735
Practice Address - Fax:610-284-8312
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014890E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006862130010Medicaid
C29949Medicare UPIN
PA0006862130010Medicaid