Healthcare Provider Details

I. General information

NPI: 1326466921
Provider Name (Legal Business Name): STORM LIEBLING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 YORK ST STE 1F
NEW HAVEN CT
06511-5664
US

IV. Provider business mailing address

100 YORK STREET SUIT 1F
NEW HAVEN CT
06511
US

V. Phone/Fax

Practice location:
  • Phone: 203-737-7440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number59171
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number29034901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: