Provider Demographics
NPI:1740248855
Name:LEBERER, JOSEPH P (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:P
Last Name:LEBERER
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 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5782
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:295 ESSJAY RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8216
Practice Address - Country:US
Practice Address - Phone:716-630-1135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1596811208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040426001895OtherFIDELIS
NY290002946OtherRR MEDICARE
NY00010101201OtherUNIVERA
NY01075772Medicaid
NY161000580OtherEMPIRE
NY24622OtherGHI
NY1402335OtherIHA
NY161000580OtherNORTH AMERICAN PREFERRED
NY000510339001OtherHEALTH NOW
NY040426001895OtherFIDELIS
NYB52742Medicare PIN