Healthcare Provider Details

I. General information

NPI: 1871562934
Provider Name (Legal Business Name): LISA A LIBERATORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 EAST 85 STREET
NEW YORK NY
10028
US

IV. Provider business mailing address

154 EAST 85 STREET
NEW YORK NY
10028
US

V. Phone/Fax

Practice location:
  • Phone: 212-288-2222
  • Fax: 212-288-8082
Mailing address:
  • Phone: 212-288-2222
  • Fax: 212-288-8082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number189838
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: