Provider Demographics
NPI:1780692335
Name:LEIBOWITZ, LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:LEIBOWITZ
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 1:36 GROVE ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5329
Mailing Address - Country:US
Mailing Address - Phone:203-966-6305
Mailing Address - Fax:203-966-4618
Practice Address - Street 1:36 GROVE ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5329
Practice Address - Country:US
Practice Address - Phone:203-966-6305
Practice Address - Fax:203-966-4618
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG97774Medicare UPIN