Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | PO0001449 | FL |
N | 222Z00000X | Podiatrist | PO0001449 | FL |
Y | 213ES0103X | Foot & Ankle Surgery | PO0001449 | FL |
N | 213ES0131X | Foot Surgery | PO0001449 | FL |
NPI | 1316980568 |
---|---|
Provider Name | Dr. Jay Alan Lieberman |
First Address | Margate, FL 33063-5715 |
Second Address | Margate, FL 33063-5715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 26/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0410667 | (05) | FL |
T55555 | (02) |