Individual provider Active NPI

Gordon Sidney Liebergall, M.D.

  • Ophthalmology Physician
  • Suffern, NY
National Provider Identifier
1689653362
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
084611 Issued in NY
Practice address
222 Route 59
Suite 207
Suffern, NY 10901-5204
Phone
(845) 357-2500
Fax
(845) 368-3937
NPI assigned
Jan 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 084611 NY Primary

Addresses

Primary practice location

222 Route 59
Suite 207
Suffern, NY 10901-5204

Mailing address

222 Route 59
Suite 207
Suffern, NY 10901-5204
Phone (845) 357-2500

Other identifiers 2

IdentifierTypeStateIssuer
00127838MedicaidNY
084611OtherNMSTATE MEDICAL LICENSE NUM

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)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

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

{
    "created_epoch": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1689653362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 ROUTE 59",
            "address_2": "SUITE 207",
            "city": "SUFFERN",
            "state": "NY",
            "postal_code": "109015204",
            "telephone_number": "845-357-2500",
            "fax_number": "845-368-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 ROUTE 59",
            "address_2": "SUITE 207",
            "city": "SUFFERN",
            "state": "NY",
            "postal_code": "109015204",
            "telephone_number": "845-357-2500",
            "fax_number": "845-368-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBERGALL",
        "first_name": "GORDON",
        "middle_name": "SIDNEY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-11",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "084611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00127838",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE NUM",
            "identifier": "084611",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Suffern, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.