1245234905 NPI number — DAVID M LIEBERS M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245234905 NPI number — DAVID M LIEBERS M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LIEBERS

Provider First Name:

DAVID

Provider Middle Name:

M

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1245234905

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1462 ERIE BLVD

Provider Second Line Business Mailing Address:

SUITE 2

Provider Business Mailing Address City Name:

SCHENECTADY

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

12305-1026

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1101 NOTT ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SCHENECTADY

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

12308-2425

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

518-243-4178

Provider Business Practice Location Address Fax Number:

518-243-4173

Provider Enumeration Date:

06/10/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RI0200X , with the licence number:  170194 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
• Taxonomy code: 207R00000X , with the licence number: 170194 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

• Identifier: 100163144729 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 2596519 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 5379710 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 040426006696 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 10487373 . This is a "CAQH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 32830 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 70E131 . This is a "EMPIRE BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 42561 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 000443021002 . This is a "BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 01034459 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".