=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457576670
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARNOLD M. LIEBERMAN, DDS & VASILIOS D. MESIMERIS, DMD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2007
-----------------------------------------------------
Last Update Date | 08/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 678 DEER PARK AVE SUITE 2
-----------------------------------------------------
City | BABYLON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11702-1319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-587-5870
-----------------------------------------------------
Fax | 631-587-7947
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 678 DEER PARK AVE
-----------------------------------------------------
City | BABYLON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11702-1319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-587-5870
-----------------------------------------------------
Fax | 631-587-7947
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | DR. ARNOLD LIEBERMAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 631-587-5870
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------