Healthcare Provider Details

I. General information

NPI: 1972544054
Provider Name (Legal Business Name): DEBORA KOGAN-LIBERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE FL 4
BRONX NY
10467-2403
US

IV. Provider business mailing address

111 E 210TH ST ROSENTHAL 3
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2332
  • Fax: 718-515-5426
Mailing address:
  • Phone: 718-741-2332
  • Fax: 718-515-5426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number25MA06234800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number003487-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: