MEDICARE: DR. LUCA GILIBERTO MD, PHD

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	2084N0400X	Neurology Physician	276460	NY
2	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	276460	NY

General Provider Information

NPI Number	:	1891082632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCA GILIBERTO MD, PHD

Provider Business Mailing Address
First Line	:	300 COMMUNITY DR
Second Line	:	NORTH SHORE-LIJ-CUSHING NEUROSCIENCE INSTITUTE-9 TOWER
City	:	MANHASSET
State	:	NY
Zip	:	11030-3816
Country	:	US
Telephone Number	:	516-562-3029
Fax Number	:	516-562-3631

Provider Business Practice Location Address
First Line	:	611 NORTHERN BLVD
Second Line	:	STE 150, NORTH SHORE-LIJ-CUSHING NEUROSCIENCE INSTITUTE
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5207
Country	:	US
Telephone Number	:	516-325-7000
Fax Number	:	516-325-7001

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

Provider Enumeration Date	:	06/30/2011
Last Update Date	:	03/12/2020

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