Active NPI
Ernest B Leibov, MD
- Psychiatry Physician
- Sparta, NJ
National Provider Identifier
1619964996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 25 MA 4350600
- Practice address
- 350 Sparta Ave
#A-5
Sparta, NJ 07871-1150 - Phone
- (973) 729-0224
- Fax
- (973) 729-0234
- NPI assigned
- Oct 3, 2005
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 25 MA 4350600 | NM | Primary |
Addresses
Primary practice location
350 Sparta Ave
#A-5
Sparta, NJ 07871-1150
Mailing address
350 Sparta Ave
#A-5
Sparta, NJ 07871-1150
Phone (973) 729-0224
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 223115510 | Other | NJ | TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25 MA 4350600 | NM | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619964996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 SPARTA AVE",
"address_2": "#A-5",
"city": "SPARTA",
"state": "NJ",
"postal_code": "078711150",
"telephone_number": "973-729-0224",
"fax_number": "973-729-0234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 SPARTA AVE",
"address_2": "#A-5",
"city": "SPARTA",
"state": "NJ",
"postal_code": "078711150",
"telephone_number": "973-729-0224",
"fax_number": "973-729-0234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEIBOV",
"first_name": "ERNEST",
"middle_name": "B",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NM",
"license": "25 MA 4350600",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "223115510",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sparta, NJ
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.