Healthcare Provider Details

I. General information

NPI: 1518065085
Provider Name (Legal Business Name): ARNOLD M. LIEBERMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

678 DEER PARK AVE
BABYLON NY
11702-1319
US

IV. Provider business mailing address

678 DEER PARK AVE
BABYLON NY
11702-1319
US

V. Phone/Fax

Practice location:
  • Phone: 631-587-5870
  • Fax:
Mailing address:
  • Phone: 631-587-5870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number23647
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: