Individual
DR. WILFRED LIEBERTHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
26 RESEARCH WAY, EAST SETAUKET, NY 11733
(631) 444-0580
Mailing address
P.O. BOX 1559, STONY BROOK, NY 11790
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
236326
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02005416
—
NY
01
—
1807U3
EMPIRE BC.BS
NY
01
—
5940445
AETNA
NY
Enumeration date
07/30/2006
Last updated
07/08/2007
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