Bertram Sidney Liebross, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

101408 Issued in NY

Practice address

55 Greenleaf HL
Great Neck, NY 11023-1809

Phone

(516) 829-3794

Fax

(516) 829-3794

NPI assigned

Dec 28, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1518023498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 GREENLEAF HL",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110231809",
            "telephone_number": "516-829-3794",
            "fax_number": "516-829-3794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 GREENLEAF HL",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110231809",
            "telephone_number": "516-829-3794",
            "fax_number": "516-829-3794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBROSS",
        "first_name": "BERTRAM",
        "middle_name": "SIDNEY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "101408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kun Li
• Julie Liberman, DDS
• Margery J Libin, LCSW
• H. David Lieberman, MD
• Ethan John Liebler, MSPT
• Thelma Ruth Liebross, DDS
• Lifeguard Medical PLLC
• Julie Michele Liff, PT, DPT
• David Matthew Light, M.D.
• Alesia Lika, RPH

• Family Medicine Physician in Great Neck, NY
• Providers in Great Neck, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.