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General NPI Number Information
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NPI Number | 1144406232
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Entity Type | Organization
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Legal Business Name | M LEIBMAN OBGYN LLC
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 100 STATE ST SUITE 1A
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City | TEANECK
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State | NJ
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Zip | 07666-5200
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Country | US
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Telephone | 201-837-2100
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Fax | 201-837-2188
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Provider Business Mailing Address
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Address Line | 100 STATE ST SUITE 1A
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City | TEANECK
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State | NJ
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Zip | 07666-5200
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Country | US
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Telephone | 201-837-2100
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Fax | 201-837-2188
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL ROY LEIBMAN
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Credential | M.D.
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Telephone | 201-837-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MA60838
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License Number State | NJ
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