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Individual

DR. OLAF U LIEBERG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
789 PRE EMPTION RD, SUITE 600, GENEVA, NY 14456-2069
(315) 719-0060
(315) 719-0230
Mailing address
PO BOX 1077, GENEVA, NY 14456-8077
(315) 719-0060
(315) 719-0230

Taxonomy

Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
118724
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00436508
NY
01
0598530
GHI
01
100675CU
PREFERRED CARE
01
1187244W
WORKERS COMPENSATION
NY
01
P00307208
RAILROAD MEDICARE
01
P010118724
BLUE CHOICE
01
P030118724
ROCHESTER BLUE SHIELD
Enumeration date
05/24/2006
Last updated
10/29/2009
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