Individual provider Active NPI

Alan Howard Lieberman, MD

  • Urology Physician
  • Monroe, NJ
National Provider Identifier
1376629014
Registry record updated Sep 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
25MA03429900 Issued in NJ
Practice address
52 Constitution Dr
Monroe, NJ 08831-7935
Phone
(732) 349-5200
Fax
(732) 349-5235
NPI assigned
Oct 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 25MA03429900 NJ Primary

Addresses

Primary practice location

52 Constitution Dr
Monroe, NJ 08831-7935

Mailing address

52 Constitution Dr
Monroe, NJ 08831-7935
Phone (732) 349-5200

Other identifiers 1

IdentifierTypeStateIssuer
0699004MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150521001112 NJ Order and Referring Only - UrologyPractitioner - Urology 9436192820

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA03429900NJMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shore Medical Specialists Past Accepting new patients
Ocean Urology Group PA. PastSince May 11, 1993 Accepting new patients
Lakewood Surgical Group PA Past Accepting new patients

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410480000000",
    "number": "1376629014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 CONSTITUTION DR",
            "city": "MONROE",
            "state": "NJ",
            "postal_code": "088317935",
            "telephone_number": "732-349-5200",
            "fax_number": "732-349-5235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 CONSTITUTION DR",
            "city": "MONROE",
            "state": "NJ",
            "postal_code": "088317935",
            "telephone_number": "732-349-5200",
            "fax_number": "732-349-5235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBERMAN",
        "first_name": "ALAN",
        "middle_name": "HOWARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2014-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NJ",
            "license": "25MA03429900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0699004",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, NJ

Sources for this page

Verify at the official NPI Registry.