MEDICARE: DR. JONATHAN LIEBLICH MD

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	207L00000X	Anesthesiology Physician	213763	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063412328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN LIEBLICH MD

Provider Business Mailing Address
First Line	:	43 KENSICO DR
Second Line	:	2ND FLOOR
City	:	MOUNT KISCO
State	:	NY
Zip	:	10549-1009
Country	:	US
Telephone Number	:	914-666-8866
Fax Number	:	914-666-6777

Provider Business Practice Location Address
First Line	:	670 STONELEIGH AVE
Second Line	:	PUTNAM HOSPITAL
City	:	CARMEL
State	:	NY
Zip	:	10512-3997
Country	:	US
Telephone Number	:	845-279-5711
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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