Provider Demographics
NPI:1447242920
Name:LIEB, IRWIN M (MD)
Entity type:Individual
Prefix:
First Name:IRWIN
Middle Name:M
Last Name:LIEB
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:309 COUNTY ROUTE 47
Mailing Address - Street 2:STE 4
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-5405
Mailing Address - Country:US
Mailing Address - Phone:518-891-1610
Mailing Address - Fax:518-891-5726
Practice Address - Street 1:309 COUNTY ROUTE 47
Practice Address - Street 2:STE 4
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5405
Practice Address - Country:US
Practice Address - Phone:518-891-1610
Practice Address - Fax:518-891-5726
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
NY168738208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01022339Medicaid
D01964Medicare UPIN
33431JMedicare ID - Type Unspecified