Healthcare Provider Details

I. General information

NPI: 1154322188
Provider Name (Legal Business Name): ARNOLD ROBERT LEIBOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 NESCONSET HIGHWAY SUITE 100
EAST SETAUKET NY
11733
US

IV. Provider business mailing address

3400 NESCONSET HIGHWAY SUITE 100
EAST SETAUKET NY
11733
US

V. Phone/Fax

Practice location:
  • Phone: 631-689-2600
  • Fax: 631-689-2943
Mailing address:
  • Phone: 631-689-2600
  • Fax: 631-689-2943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number142014
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: