Healthcare Provider Details

I. General information

NPI: 1174588610
Provider Name (Legal Business Name): MELANIE ALISSA LEBERMAN RPAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5879 SNYDER DR
LOCKPORT NY
14094-9497
US

IV. Provider business mailing address

5879 SNYDER DR
LOCKPORT NY
14094-9497
US

V. Phone/Fax

Practice location:
  • Phone: 716-433-8751
  • Fax: 716-433-8792
Mailing address:
  • Phone: 716-433-8751
  • Fax: 716-433-8792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number009450
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: