Healthcare Provider Details

I. General information

NPI: 1780973909
Provider Name (Legal Business Name): ALICIA ANNE LIEBERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5762 E MAIN STREET RD STE D
BATAVIA NY
14020-9649
US

IV. Provider business mailing address

913 CULVER RD
ROCHESTER NY
14609-7141
US

V. Phone/Fax

Practice location:
  • Phone: 585-304-8118
  • Fax:
Mailing address:
  • Phone: 585-654-5432
  • Fax: 585-288-7871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number271529
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number271529
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: