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General NPI Number Information
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NPI Number | 1619964996
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Entity Type | Individual
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Provider Name | ERNEST B LEIBOV MD
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Gender | Male
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Dates
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Enumeration Date | 10/03/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 350 SPARTA AVE #A-5
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City | SPARTA
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State | NJ
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Zip | 07871-1150
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Country | US
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Telephone | 973-729-0224
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Fax | 973-729-0234
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Provider Business Mailing Address
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Address Line | 350 SPARTA AVE #A-5
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City | SPARTA
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State | NJ
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Zip | 07871-1150
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Country | US
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Telephone | 973-729-0224
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Fax | 973-729-0234
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25 MA 4350600
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License Number State | NM
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