Provider Demographics
NPI:1649339037
Name:IRVIN M LIEBMAN, M.D. PC
Entity type:Organization
Organization Name:IRVIN M LIEBMAN, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN - PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIEBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:215-441-0999
Mailing Address - Street 1:PO BOX 1531
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-0880
Mailing Address - Country:US
Mailing Address - Phone:856-753-0913
Mailing Address - Fax:856-753-4490
Practice Address - Street 1:205 NEWTOWN RD
Practice Address - Street 2:SUITE 216
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-5275
Practice Address - Country:US
Practice Address - Phone:856-753-0913
Practice Address - Fax:856-753-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028206L207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB32425Medicare UPIN