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General NPI Number Information
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NPI Number | 1235594854
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Entity Type | Organization
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Legal Business Name | LEIBOVICI HEALTH CARE LLC
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Dates
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Enumeration Date | 12/24/2015
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 421 VAN WYCK MEWS
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City | NORFOLK
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State | VA
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Zip | 23517-2129
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Country | US
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Telephone | 757-373-8438
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Fax | 757-333-7736
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Provider Business Mailing Address
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Address Line | 421 VAN WYCK MEWS
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City | NORFOLK
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State | VA
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Zip | 23517-2129
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Country | US
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Telephone | 757-373-8438
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Fax | 757-333-7736
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMUEL LEIBOVICI
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Credential | M.D.
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Telephone | 757-373-8438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 0101237467
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License Number State | VA
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