MELISSA LIEBOLD

PORT JEFFERSON STATION, NY
NPI1235725672
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363A00000X Physician Assistant
(Licence: NY  026336)
Additional Taxonomies390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2020-12-20
Last Update Date2024-03-01
Business Address
MELISSA LIEBOLD PA-C
1500 ROUTE 112 STE A
PORT JEFFERSON STATION, NY 11776-8055
Phone number: 631-265-4200
Mailing Address
MELISSA LIEBOLD PA-C
91 DORCHESTER RD
LAKE RONKONKOMA, NY 11779-1616
Phone number: 631-338-0711