Healthcare Provider Details

I. General information

NPI: 1326276254
Provider Name (Legal Business Name): STEVEN LIEBERMAN, OD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98120 QUEENS BLVD #1JK
REGO PARK NY
11374-4357
US

IV. Provider business mailing address

98120 QUEENS BLVD #1JK
REGO PARK NY
11374-4357
US

V. Phone/Fax

Practice location:
  • Phone: 718-896-4646
  • Fax:
Mailing address:
  • Phone: 718-896-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN LIEBERMAN
Title or Position: OPTOMETRIST
Credential: OD
Phone: 718-896-4646