Provider Demographics
NPI:1336183888
Name:LIBEN, ERIC PAUL (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:PAUL
Last Name:LIBEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2365
Mailing Address - Country:US
Mailing Address - Phone:203-234-1891
Mailing Address - Fax:203-234-7037
Practice Address - Street 1:100 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2365
Practice Address - Country:US
Practice Address - Phone:203-234-1891
Practice Address - Fax:203-234-7037
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010025715CT03OtherANTHEM BLUECROSS/BLUESHIE
CT0460198OtherAETNA
CT257150OtherCONNECTICARE
CT001257153Medicaid
CT110180168OtherRAILROAD MEDICARE
CT01025715OtherCIGNA
CT061535742OtherUNITED HEALTH CARE
CT0Q1451OtherHEALTHNET
CTP522302OtherOXFORD
CT01025715OtherCIGNA
CTD83542Medicare UPIN