MEDICARE: DR. JEFFREY A LIBERMAN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	206490-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	101701BJ	OTHER	NY	PREFERRED CARE
3	P010206490	OTHER	NY	EXCELLUS BC/BS

General Provider Information

NPI Number	:	1205836772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY A LIBERMAN DO

Provider Business Mailing Address
First Line	:	485 TITUS AVE
Second Line	:	STE H
City	:	ROCHESTER
State	:	NY
Zip	:	14617-3535
Country	:	US
Telephone Number	:	585-544-5368
Fax Number	:	585-278-5304

Provider Business Practice Location Address
First Line	:	485 TITUS AVE
Second Line	:	STE H
City	:	ROCHESTER
State	:	NY
Zip	:	14617-3535
Country	:	US
Telephone Number	:	585-544-5368
Fax Number	:	585-278-5304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	03/19/2010

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