Healthcare Provider Details

I. General information

NPI: 1518150572
Provider Name (Legal Business Name): MELANIE LIEBER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E SUNRISE HWY 5TH FL.
VALLEY STREAM NY
11581-1233
US

IV. Provider business mailing address

410 LAKEVILLE ROAD SUITE 206A
NEW HYDE PARK NY
11040
US

V. Phone/Fax

Practice location:
  • Phone: 516-825-3600
  • Fax: 516-823-2096
Mailing address:
  • Phone: 718-470-7644
  • Fax: 718-470-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009279
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: