Individual provider Active NPI

Paul Liebhaber, P.T

  • Specialist
  • Roslyn, NY
National Provider Identifier
1144383712
Registry record updated May 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
4913 Issued in NY
Practice address
63 Mineola Ave
Roslyn, NY 11576-2001
Phone
(516) 484-0515
Fax
(516) 625-4546
NPI assigned
Dec 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 4, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 4913 NY Primary

Addresses

Primary practice location

63 Mineola Ave
Roslyn, NY 11576-2001

Mailing address

63 Mineola Ave
Roslyn, NY 11576-2001
Phone (516) 484-0515

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120328000221 NY Practitioner - Physical Therapist in Private Practice 7719145366 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4913NYMDSpecialist
004913NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Nassau Physical Therapy and Rehabilitation ,PC CurrentSince Feb 28, 2012 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272931200000",
    "number": "1144383712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 MINEOLA AVE",
            "city": "ROSLYN",
            "state": "NY",
            "postal_code": "115762001",
            "telephone_number": "516-484-0515",
            "fax_number": "516-625-4546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 MINEOLA AVE",
            "city": "ROSLYN",
            "state": "NY",
            "postal_code": "115762001",
            "telephone_number": "516-484-0515",
            "fax_number": "516-625-4546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBHABER",
        "first_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "P.T",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2010-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "4913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roslyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.