Healthcare Provider Details

I. General information

NPI: 1396844163
Provider Name (Legal Business Name): COLETTE D LIEBER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FRANKLIN TPK SUITE 208
MAHWAH NJ
07430
US

IV. Provider business mailing address

400 FRANKLIN TURNPIKE SUITE 208
MAHWAH NJ
07430
US

V. Phone/Fax

Practice location:
  • Phone: 201-825-0009
  • Fax: 201-825-2622
Mailing address:
  • Phone: 201-825-0009
  • Fax: 201-825-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number51951
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: