Healthcare Provider Details

I. General information

NPI: 1457477499
Provider Name (Legal Business Name): CURTIS CHARLES LIEBER P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GEORGE ST
OSWEGO NY
13126-3276
US

IV. Provider business mailing address

239 ONEIDA ST
FULTON NY
13069-1228
US

V. Phone/Fax

Practice location:
  • Phone: 315-598-4790
  • Fax: 315-593-6195
Mailing address:
  • Phone: 315-598-4715
  • Fax: 315-598-4733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number015635
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: