Healthcare Provider Details

I. General information

NPI: 1811944267
Provider Name (Legal Business Name): MICHAEL LIEBERSTEIN P.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 PLAINVIEW AVE
FAR ROCKAWAY NY
11691-5540
US

IV. Provider business mailing address

907 PLAINVIEW AVE
FAR ROCKAWAY NY
11691-5540
US

V. Phone/Fax

Practice location:
  • Phone: 917-655-9620
  • Fax:
Mailing address:
  • Phone: 917-655-9620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number014612
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: