| Jeffrey Lieberman, | |
|
3055 Southwestern Blvd, Suite 104, Orchard Park, NY 14127-1231 | |
| (716) 677-6736 | |
| (716) 677-6144 |
| Full Name | Jeffrey Lieberman |
|---|---|
| Gender | Male |
| Speciality | Radiology - Diagnostic Radiology |
| Location | 3055 Southwestern Blvd, Orchard Park, New York |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932109253 | NPI | - | NPPES |
| 00040819806 | Other | UNIVERA | |
| 300136886 | Other | NY | RAILROAD MEDICARE |
| P00420095 | Other | RAILROAD MEDICARE | |
| CRDRA1829183 | Other | NY | WORKERS COMPENSATION |
| 000523824010 | Other | BLUE SHIELD OF WESTERN NY | |
| 208616656 | Other | FIDELIS | |
| 01616022 | Medicaid | NY | |
| 5608639 | Other | INDEPENDANT HEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | 182918 (New York) | Primary |
| Entity Name | Western New York Radiology Associates Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1285682500 PECOS PAC ID: 3072402296 Enrollment ID: O20040315000217 |
| Entity Name | Great Lakes Medical Imaging Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1861763005 PECOS PAC ID: 2163681859 Enrollment ID: O20120316000017 |
| Entity Name | Olean Medical Practice Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1285384412 PECOS PAC ID: 0042698045 Enrollment ID: O20220603000542 |
| Mailing Address | Practice Location Address |
|---|---|
| Jeffrey Lieberman, 51 S Meadow Dr, Orchard Park, NY 14127-2722 Ph: (716) 662-0293 | Jeffrey Lieberman, 3055 Southwestern Blvd, Suite 104, Orchard Park, NY 14127-1231 Ph: (716) 677-6736 |
Stephanie L Soehnlein, M.D. Radiology Medicare: Medicare Enrolled Practice Location: 3900 N Buffalo St, Orchard Park, NY 14127 Phone: 716-630-1112 Fax: 716-631-1178 | |
Dr. Henry Frederick Goller, M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 40 Brookins Green Dr, Orchard Park, NY 14127 Phone: 716-662-3871 | |
John Michael Reiser, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 40 Birdsong Pkwy, Orchard Park, NY 14127 Phone: 716-574-2672 |