Healthcare Provider Details

I. General information

NPI: 1972628295
Provider Name (Legal Business Name): EDWARD JOSHUA LIEBERMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 MADISON AVE SUITE 1712
NEW YORK NY
10022-5501
US

IV. Provider business mailing address

78 RIDGE RD
KATONAH NY
10536-1009
US

V. Phone/Fax

Practice location:
  • Phone: 212-759-4486
  • Fax:
Mailing address:
  • Phone: 914-232-0680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number033352
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: