Provider Demographics
NPI:1013919521
Name:LIEBERMAN, STEVEN (OD, FAAO, PC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:OD, FAAO, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98120 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4357
Mailing Address - Country:US
Mailing Address - Phone:718-896-4646
Mailing Address - Fax:718-897-1114
Practice Address - Street 1:98120 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4357
Practice Address - Country:US
Practice Address - Phone:718-896-4646
Practice Address - Fax:718-897-1114
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV002959-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400006721OtherGROUP PTAN
NYU25180Medicare UPIN
NYG400006721OtherGROUP PTAN