Healthcare Provider Details

I. General information

NPI: 1811429319
Provider Name (Legal Business Name): DANIEL GARY LIEBERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ENGLE ST STE 6501
ENGLEWOOD NJ
07631-1808
US

IV. Provider business mailing address

400 E 85TH ST APT 7B
NEW YORK NY
10028-6303
US

V. Phone/Fax

Practice location:
  • Phone: 201-608-2800
  • Fax:
Mailing address:
  • Phone: 845-588-8865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number25MA12334800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: