Provider Demographics
NPI:1912140997
Name:LIEGNER, KENNETH BRUCE (MD, PC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:BRUCE
Last Name:LIEGNER
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Gender:M
Credentials:MD, PC
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Mailing Address - Street 1:55 ROUTE 22
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564
Mailing Address - Country:US
Mailing Address - Phone:845-493-0274
Mailing Address - Fax:845-493-0279
Practice Address - Street 1:592 ROUTE 22
Practice Address - Street 2:SUITE 1B
Practice Address - City:PAWLING
Practice Address - State:NY
Practice Address - Zip Code:12564
Practice Address - Country:US
Practice Address - Phone:845-493-0274
Practice Address - Fax:845-493-0279
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2010-09-07
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Provider Licenses
StateLicense IDTaxonomies
NY132316207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE87408Medicare UPIN