Healthcare Provider Details

I. General information

NPI: 1811625163
Provider Name (Legal Business Name): SAMANTHA LIEBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10470 QUEENS BLVD STE 200
FOREST HILLS NY
11375-3694
US

IV. Provider business mailing address

1 THE PROMENADE
NEW CITY NY
10956-4122
US

V. Phone/Fax

Practice location:
  • Phone: 718-275-6010
  • Fax:
Mailing address:
  • Phone: 845-499-9585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: