Healthcare Provider Details

I. General information

NPI: 1568482230
Provider Name (Legal Business Name): BRUCE LAWRENCE LIEBERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 E BUTLER AVE SUITE 201
NEW BRITAIN PA
18901-5257
US

IV. Provider business mailing address

65 E BUTLER AVE SUITE 201
NEW BRITAIN PA
18901-5257
US

V. Phone/Fax

Practice location:
  • Phone: 215-822-3113
  • Fax: 215-822-0889
Mailing address:
  • Phone: 215-822-3113
  • Fax: 215-822-0889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD040140E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: