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General NPI Number Information
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NPI Number | 1760907521
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Entity Type | Individual
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Provider Name | JANE LIEBERMAN
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Gender | Female
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Dates
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Enumeration Date | 08/13/2017
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Last Update Date | 08/13/2017
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Provider Practice Location Address
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Address Line | 3020 WESTCHESTER AVE STE 200
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City | PURCHASE
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State | NY
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Zip | 10577-2510
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Country | US
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Telephone | 914-996-7786
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Fax |
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Provider Business Mailing Address
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Address Line | 176 JONES RD
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-3715
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Country | US
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Telephone | 646-808-6307
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 059151-1
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License Number State | NY
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