Healthcare Provider Details

I. General information

NPI: 1821880188
Provider Name (Legal Business Name): STEFAN LIEBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 77TH ST
NEW YORK NY
10075-1850
US

IV. Provider business mailing address

10730 EUCLID AVE APT 1005
CLEVELAND OH
44106-2272
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-2000
  • Fax:
Mailing address:
  • Phone: 216-644-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: