Healthcare Provider Details

I. General information

NPI: 1265455109
Provider Name (Legal Business Name): KENT A LIEBER M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 ABBOTT RD
BUFFALO NY
14220-2039
US

IV. Provider business mailing address

PO BOX 2774
BUFFALO NY
14240-2774
US

V. Phone/Fax

Practice location:
  • Phone: 716-864-6842
  • Fax: 716-568-8455
Mailing address:
  • Phone: 716-864-6842
  • Fax: 716-568-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number170279
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: