Healthcare Provider Details

I. General information

NPI: 1659638708
Provider Name (Legal Business Name): JEREMY MICHAEL LIFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NORTHERN BLVD SUITE 207
GREENVALE NY
11548
US

IV. Provider business mailing address

43 WESTMINSTER AVE
BERGENFIELD NJ
07621-3913
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-1270
  • Fax:
Mailing address:
  • Phone: 201-387-1957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA09113800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME162264
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME162264
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number259539-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number259539
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberME162264
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number259539
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number259539
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number25MA09113800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: