Individual provider Active NPI

H. David Lieberman, MD

  • Specialist
  • Great Neck, NY
National Provider Identifier
1639104805
Registry record updated Dec 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
125162 Issued in NY
Practice address
277 Northern Blvd
Suite 304
Great Neck, NY 11021-4703
Phone
(516) 829-0105
Fax
(516) 487-7240
NPI assigned
Jul 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 16, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 125162 NY Primary

Addresses

Primary practice location

277 Northern Blvd
Suite 304
Great Neck, NY 11021-4703

Mailing address

277 Northern Blvd
Suite 304
Great Neck, NY 11021-4703
Phone (516) 829-0105

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20041109000373 NY Practitioner - EndocrinologyPractitioner - Internal Medicine 7214990498 Practice locations: Great Neck, NY

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Internal Medicine
Education
Other, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

560 Northern Blvd
Suite 107
Great Neck, NY 11021-5100
Phone (516) 829-0105

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125162NYMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Bay Rheumatology, M.D., P.C. Past 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 and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260921600000",
    "number": "1639104805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 NORTHERN BLVD",
            "address_2": "SUITE 304",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214703",
            "telephone_number": "516-829-0105",
            "fax_number": "516-487-7240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 NORTHERN BLVD",
            "address_2": "SUITE 304",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214703",
            "telephone_number": "516-829-0105",
            "fax_number": "516-487-7240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBERMAN",
        "first_name": "H.",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2009-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "125162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

Verify at the official NPI Registry.