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General NPI Number Information
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NPI Number | 1659638708
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Entity Type | Individual
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Provider Name | JEREMY MICHAEL LIFF M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2012
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 2200 NORTHERN BLVD SUITE 207
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City | GREENVALE
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State | NY
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Zip | 11548
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Country | US
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Telephone | 718-630-1270
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Fax |
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Provider Business Mailing Address
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Address Line | 43 WESTMINSTER AVE
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City | BERGENFIELD
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State | NJ
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Zip | 07621-3913
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Country | US
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Telephone | 201-387-1957
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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 | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 259539
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | 259539-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 259539
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA09113800
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 259539
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | 25MA09113800
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License Number State | NJ
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