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General NPI Number Information
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NPI Number | 1437771961
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Entity Type | Individual
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Provider Name | MALLORY JANE LEIBMAN DMD
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Gender | Female
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 49 W 12TH ST STE 1F
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City | NEW YORK
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State | NY
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Zip | 10011-8530
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Country | US
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Telephone | 212-682-9555
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Fax |
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Provider Business Mailing Address
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Address Line | 118 S HIGHWOOD AVE
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City | GLEN ROCK
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State | NJ
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Zip | 07452-1511
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Country | US
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Telephone | 201-469-7386
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02853600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 062050
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License Number State | NY
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