Provider Demographics
NPI:1588892830
Name:LIEB, JAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:JAYNE
Middle Name:
Last Name:LIEB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1978 CROMPOND RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-4114
Mailing Address - Country:US
Mailing Address - Phone:914-293-8600
Mailing Address - Fax:
Practice Address - Street 1:1978 CROMPOND RD STE 101
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4114
Practice Address - Country:US
Practice Address - Phone:914-293-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103654208600000X
NY240034208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery