MEDICARE: DR. SUSAN RENEE KOLIN-LIEBMAN D.M.D.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	040156	NY

General Provider Information

NPI Number	:	1700959756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN RENEE KOLIN-LIEBMAN D.M.D.

Provider Business Mailing Address
First Line	:	185 MONTAGUE ST
Second Line	:	8TH FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3608
Country	:	US
Telephone Number	:	718-622-6741
Fax Number	:	718-622-5125

Provider Business Practice Location Address
First Line	:	185 MONTAGUE ST
Second Line	:	8TH FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3608
Country	:	US
Telephone Number	:	718-622-6741
Fax Number	:	718-622-5125

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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