Healthcare Provider Details

I. General information

NPI: 1538429881
Provider Name (Legal Business Name): TRACEY NICOLE LIEBMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E 41ST ST FL 16
NEW YORK NY
10017-6739
US

IV. Provider business mailing address

222 E 41ST ST FL 16
NEW YORK NY
10017-6739
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5889
  • Fax: 212-263-7680
Mailing address:
  • Phone: 212-263-5889
  • Fax: 212-263-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number282571
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: