Individual
JEFFREY LIEBERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3055 SOUTHWESTERN BLVD, SUITE 104, ORCHARD PARK, NY 14127-1231
(716) 677-6736
(716) 677-6144
Mailing address
51 S MEADOW DR, ORCHARD PARK, NY 14127-2722
(716) 662-0293
(716) 402-1862
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
182918
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00040819806
UNIVERA
—
01
—
000523824010
BLUE SHIELD OF WESTERN NY
—
05
—
01616022
—
NY
01
—
208616656
FIDELIS
—
01
—
300136886
RAILROAD MEDICARE
NY
01
—
5608639
INDEPENDANT HEALTH
—
01
—
CRDRA1829183
WORKERS COMPENSATION
NY
01
—
P00420095
RAILROAD MEDICARE
—
Enumeration date
07/28/2005
Last updated
07/17/2012
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