Healthcare Provider Details

I. General information

NPI: 1568458214
Provider Name (Legal Business Name): HOWARD M LEIBOWITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 BAY ST SUITE 201
TAUNTON MA
02780-1085
US

IV. Provider business mailing address

2005 BAY ST SUITE 201
TAUNTON MA
02780-1085
US

V. Phone/Fax

Practice location:
  • Phone: 508-823-7473
  • Fax: 508-824-3830
Mailing address:
  • Phone: 508-823-7473
  • Fax: 508-824-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number28043
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: