Provider Demographics
NPI:1578681813
Name:LEIFER, IRA (PHD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:
Last Name:LEIFER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5217
Mailing Address - Country:US
Mailing Address - Phone:718-471-6260
Mailing Address - Fax:
Practice Address - Street 1:28 GARDEN CT
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5217
Practice Address - Country:US
Practice Address - Phone:718-471-6260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010771103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6803593OtherGHI PROVIDER #
NYOXFORDOtherOXFORD PROVIDER #
NYVALUE OPTIONSOther081787