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General NPI Number Information
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NPI Number | 1669537635
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Entity Type | Individual
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Provider Name | DANIEL LIEBERMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/25/2015
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Provider Practice Location Address
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Address Line | 92 TRAFFIC AVENUE
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City | OCEAN BAY PARK
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State | NY
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Zip | 11779
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Country | US
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Telephone | 631-495-1801
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Fax | 631-423-0688
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Provider Business Mailing Address
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Address Line | PO BOX 788
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City | OCEAN BEACH
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State | NY
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Zip | 11770-0788
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Country | US
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Telephone | 631-495-1801
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Fax | 631-423-0688
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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 | 178079
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 178079
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 14585
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License Number State | HI
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