Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0106X | Orthopaedic Hand Surgeon | 220082 | MA |
Y | 2086S0105X | Surgery of the Hand | 220082 | MA |
NPI | 1285680330 |
---|---|
Provider Name | Dr. Matthew I Leibman |
First Address | Newton, MA 02462 |
Second Address | Newton, MA 02462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 06/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2069491 | (05) | MA |
I10315 | (02) | MA |