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General NPI Number Information
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NPI Number | 1316159247
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Entity Type | Individual
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Provider Name | DMITRY LIBMAN PT
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 46 HARRIMAN DR
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City | GOSHEN
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State | NY
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Zip | 10924-2410
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Country | US
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Telephone | 800-501-3936
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 513
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City | CHESTER
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State | NY
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Zip | 10918-0513
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Country | US
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Telephone | 860-227-8795
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 029202-1
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License Number State | NY
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