Active NPI
Wilfred Lieberthal, M.D.
- Nephrology Physician
- East Setauket, NY
National Provider Identifier
1972518793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- 236326
- Practice address
- 26 Research Way
East Setauket, NY 11733 - Phone
- (631) 444-0580
- NPI assigned
- Jul 30, 2006
- 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 |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 236326 | NY | Primary |
Addresses
Primary practice location
26 Research Way
East Setauket, NY 11733
Mailing address
P.O. Box 1559
Stony Brook, NY 11790
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5940445 | Other | NY | AETNA |
| 02005416 | Medicaid | NY | |
| 1807U3 | Other | NY | EMPIRE BC.BS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 236326 | NY | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Evans Medical Foundation, Inc. | Nephrology | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972518793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 1559",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "11790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 RESEARCH WAY",
"city": "EAST SETAUKET",
"state": "NY",
"postal_code": "11733",
"telephone_number": "631-444-0580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIEBERTHAL",
"first_name": "WILFRED",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "NY",
"license": "236326",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5940445",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02005416",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE BC.BS",
"identifier": "1807U3",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Setauket, NY
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.