Provider Demographics
NPI:1154348175
Name:LIEBMAN, KENNETH M (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:LIEBMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER BLVD STE 232
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3902
Mailing Address - Country:US
Mailing Address - Phone:844-464-6387
Mailing Address - Fax:215-239-3037
Practice Address - Street 1:3100 PRINCETON PIKE BLDG 3
Practice Address - Street 2:SUITE D
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2300
Practice Address - Country:US
Practice Address - Phone:844-464-6387
Practice Address - Fax:215-239-3037
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424987207T00000X
NJ25MA06614000207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010465710002Medicaid
NJ7449801Medicaid
PAP01269402OtherRAILROAD MEDICARE
PA1010465710002Medicaid
PA309932ZM1MMedicare PIN
PAP01269402OtherRAILROAD MEDICARE
PA082606YUE7Medicare PIN
NJ958368YHDMMedicare PIN