Healthcare Provider Details

I. General information

NPI: 1003818931
Provider Name (Legal Business Name): ALEKSANDRA LIBERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 W MONTAUK HWY SUITE H
HAMPTON BAYS NY
11946-2345
US

IV. Provider business mailing address

182 W MONTAUK HWY SUITE H
HAMPTON BAYS NY
11946-2345
US

V. Phone/Fax

Practice location:
  • Phone: 631-723-0022
  • Fax: 631-723-3304
Mailing address:
  • Phone: 631-723-0022
  • Fax: 631-723-3304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number210674
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number210674
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: