Healthcare Provider Details

I. General information

NPI: 1932094729
Provider Name (Legal Business Name): ANGELENE LIEBERMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 WOODBURY RD
WOODBURY NY
11797-1407
US

IV. Provider business mailing address

116 WOODBURY RD
WOODBURY NY
11797-1407
US

V. Phone/Fax

Practice location:
  • Phone: 516-888-1224
  • Fax: 516-224-4240
Mailing address:
  • Phone: 631-464-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number357070
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: