Healthcare Provider Details

I. General information

NPI: 1598861247
Provider Name (Legal Business Name): PETER SELIG LIEBERT M.D., FACS, FAAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 WESTCHESTER AVE SUITE 403
WHITE PLAINS NY
10604-2906
US

IV. Provider business mailing address

222 WESTCHESTER AVE SUITE 403
WHITE PLAINS NY
10604-2906
US

V. Phone/Fax

Practice location:
  • Phone: 914-428-3533
  • Fax: 914-946-8766
Mailing address:
  • Phone: 914-428-3533
  • Fax: 914-946-8766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number093575
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number028589
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: