Healthcare Provider Details

I. General information

NPI: 1518982610
Provider Name (Legal Business Name): OLGA LIBERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLGA GLUSHETS

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S CENTRAL AVE
VALLEY STREAM NY
11580-5443
US

IV. Provider business mailing address

5 E 98TH ST BOX 1174
NEW YORK NY
10029-6501
US

V. Phone/Fax

Practice location:
  • Phone: 516-763-7820
  • Fax: 516-763-7825
Mailing address:
  • Phone: 212-241-7952
  • Fax: 212-241-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number238040
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number238040
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: