Healthcare Provider Details

I. General information

NPI: 1346202108
Provider Name (Legal Business Name): ROBERT LIEBENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD WCB BLDG 4TH FL
PHILADELPHIA PA
19141
US

IV. Provider business mailing address

101 EAST OLNEY AVENUE SUITE 400
PHILADELPHIA PA
19120
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-7900
  • Fax: 215-456-3428
Mailing address:
  • Phone: 215-456-7000
  • Fax: 215-254-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD020513E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: