Provider Demographics
NPI:1386915544
Name:LIEBER, MARVIN (MD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:LIEBER
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 1:2544 W MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1183
Mailing Address - Country:US
Mailing Address - Phone:623-551-7552
Mailing Address - Fax:
Practice Address - Street 1:58 SYCAMORE CIR
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3147
Practice Address - Country:US
Practice Address - Phone:516-607-6071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1216192080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine