Provider Demographics
NPI:1366550766
Name:LEIBOWITZ, LAWRENCE S (DPM)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:S
Last Name:LEIBOWITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3699 ROUTE 46
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054
Mailing Address - Country:US
Mailing Address - Phone:973-263-1776
Mailing Address - Fax:973-263-1776
Practice Address - Street 1:3699 ROUTE 46
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1049
Practice Address - Country:US
Practice Address - Phone:973-263-1776
Practice Address - Fax:973-263-1776
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01633213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1484702Medicaid
LE483648Medicare ID - Type Unspecified
T45602Medicare UPIN