Provider Demographics
NPI:1336579945
Name:LIEBOWITZ, ROBIN (LAC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:LIEBOWITZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 MAIN ST
Mailing Address - Street 2:APT 2S
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6948
Mailing Address - Country:US
Mailing Address - Phone:631-629-5717
Mailing Address - Fax:
Practice Address - Street 1:52 ELM ST STE 6
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3492
Practice Address - Country:US
Practice Address - Phone:631-629-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004820171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist