Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | O827651 | NY |
NPI | 1114982816 |
---|---|
Provider Name | Leslie Libow |
First Address | New York, NY 10029 |
Second Address | New York, NY 10029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01505820 | (05) | NY |
C07648 | (02) |