Healthcare Provider Details

I. General information

NPI: 1497192108
Provider Name (Legal Business Name): JAMES M LIGUORI PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 MARCUS AVE SUITE M11
NEW HYDE PARK NY
11042-1033
US

IV. Provider business mailing address

1999 MARCUS AVE SUITE M11
NEW HYDE PARK NY
11042-1033
US

V. Phone/Fax

Practice location:
  • Phone: 516-326-7839
  • Fax:
Mailing address:
  • Phone: 516-326-7839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number195052
License Number StateNY

VIII. Authorized Official

Name: DR. JAMES M LIGUORI
Title or Position: PRESIDENT
Credential: DO
Phone: 516-326-7839