Provider Demographics
NPI:1245358753
Name:LEIBOWITZ, MARTIN (OD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:LEIBOWITZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2402
Mailing Address - Country:US
Mailing Address - Phone:631-286-6039
Mailing Address - Fax:
Practice Address - Street 1:5801 SUNRISE HIGHWAY
Practice Address - Street 2:SUITE 41
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741
Practice Address - Country:US
Practice Address - Phone:631-567-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003374-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist