Individual provider Active NPI

David Manuel Lieberman, D.D.S.

  • General Practice Dentistry
  • Lindenhurst, NY
National Provider Identifier
1710299193
Registry record updated Jul 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
039653-1 Issued in NY
Practice address
656 N Wellwood Ave
Lindenhurst, NY 11757-1695
Phone
(631) 225-1010
Fax
(631) 225-1004
NPI assigned
Jul 13, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 13, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 039653-1 NY Primary

Addresses

Primary practice location

656 N Wellwood Ave
Lindenhurst, NY 11757-1695

Mailing address

343 Kilburn Rd S
Garden City, NY 11530-5311
Phone (516) 877-2013

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160407000576 NY Order and Referring Only - DentistPractitioner - Dentist 8921306937

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
039653-1NYMDGeneral Practice Dentistry
039653NYMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1278979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278979200000",
    "number": "1710299193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 KILBURN RD S",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115305311",
            "telephone_number": "516-877-2013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "656 N WELLWOOD AVE",
            "city": "LINDENHURST",
            "state": "NY",
            "postal_code": "117571695",
            "telephone_number": "631-225-1010",
            "fax_number": "631-225-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBERMAN",
        "first_name": "DAVID",
        "middle_name": "MANUEL",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-13",
        "last_updated": "2010-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "039653-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lindenhurst, NY

Sources for this page

Verify at the official NPI Registry.