Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 19950 | MA |
NPI | 1033132493 |
---|---|
Provider Name | Dr. Joseph S Leibovici |
First Address | Norwell, MA 02061-1740 |
Second Address | Norwell, MA 02061-1740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U71618 | (02) | MA |