Healthcare Provider Details

I. General information

NPI: 1407018013
Provider Name (Legal Business Name): KATE JULIA LIEBERMAN RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 LIBERTY ST BSMT MEDHATTAN IMMEDIATE CARE
NEW YORK NY
10006-1016
US

IV. Provider business mailing address

129 W 29TH ST FL 10
NEW YORK NY
10001-5105
US

V. Phone/Fax

Practice location:
  • Phone: 646-461-2544
  • Fax: 646-461-2542
Mailing address:
  • Phone: 415-658-6791
  • Fax: 415-520-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number012442
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: