MEDICARE: PETER B. LIEBERT, M.D., P.C.

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	261QM2500X	Medical Specialty Clinic/Center	091245	NY

General Provider Information

NPI Number	:	1902113905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER B. LIEBERT, M.D., P.C.

Provider Business Mailing Address
First Line	:	1123 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-1241
Country	:	US
Telephone Number	:	212-369-8280
Fax Number	:	917-492-8129

Provider Business Practice Location Address
First Line	:	1123 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-1241
Country	:	US
Telephone Number	:	212-369-8280
Fax Number	:	917-492-8129

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PETER B. LIEBERT
Credential	:	M.D.
Telephone Number	:	212-369-8280

Provider Enumeration Date	:	09/13/2010
Last Update Date	:	09/13/2010

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