MEDICARE: DR. JOSEPH S LEIBOVICI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	19950	MA

General Provider Information

NPI Number	:	1033132493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH S LEIBOVICI

Provider Business Mailing Address
First Line	:	80 WASHINGTON ST # BLDN-51
Second Line	:
City	:	NORWELL
State	:	MA
Zip	:	02061-1740
Country	:	US
Telephone Number	:	781-871-1677
Fax Number	:	781-982-4094

Provider Business Practice Location Address
First Line	:	80 WASHINGTON ST # BLDN-51
Second Line	:
City	:	NORWELL
State	:	MA
Zip	:	02061-1740
Country	:	US
Telephone Number	:	781-871-1677
Fax Number	:	781-982-4094

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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