| Doctor Name: | DR. CHARLES LOUIS LIEBEKNECHT |
| NPI Number: | 1255505715 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | 25MB01738200 |
| Business Practice Address: | 370 South Broadway Pennsville, NJ - 080702655 |
| Business Phone Number: | 8566787819 |
| Business Fax Number: | |
| Mailing Address: | 370 South Broadway, PENNSVILLE |
| State: | NJ |
| Postal Code: | 080702655 |
| Phone Number: | 8566787819 |
| Fax Number: | |
| NPI Enumeration Date: | 04/16/2008 |
| NPI Last Update Date: | 04/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 25MB01738200 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |