Provider Demographics
NPI:1366776635
Name:FIEBERT, LEE DAVID (PHARMD, BCPS)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:DAVID
Last Name:FIEBERT
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1979 MARCUS AVE STE E124
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1062
Mailing Address - Country:US
Mailing Address - Phone:516-396-6056
Mailing Address - Fax:
Practice Address - Street 1:1979 MARCUS AVE STE E124
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1062
Practice Address - Country:US
Practice Address - Phone:516-396-6056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-19
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053565183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy