Provider Demographics
NPI:1982689378
Name:LIEB, ROBERT GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GEORGE
Last Name:LIEB
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CHARLES COLMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564-1115
Mailing Address - Country:US
Mailing Address - Phone:845-855-1100
Mailing Address - Fax:845-855-1101
Practice Address - Street 1:20 CHARLES COLMAN BLVD
Practice Address - Street 2:
Practice Address - City:PAWLING
Practice Address - State:NY
Practice Address - Zip Code:12564-1115
Practice Address - Country:US
Practice Address - Phone:845-855-1100
Practice Address - Fax:845-855-1101
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC-10797-1BOtherWORKERS COMPENSATION
NY5475660001OtherDMEPOS
NY5475660001OtherDMEPOS
NYX6V131Medicare ID - Type Unspecified
NYP3485869Medicare UPIN