Provider Demographics
NPI:1669537635
Name:LIEBERMAN, DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:OCEAN BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11770-0788
Mailing Address - Country:US
Mailing Address - Phone:631-495-1801
Mailing Address - Fax:631-423-0688
Practice Address - Street 1:92 TRAFFIC AVENUE
Practice Address - Street 2:
Practice Address - City:OCEAN BAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11779
Practice Address - Country:US
Practice Address - Phone:631-495-1801
Practice Address - Fax:631-423-0688
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1780792084P0800X, 2084P0804X
HI145852084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry