MEDICARE: MR. JEFFREY LIBERMAN R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	018639	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1174520779	OTHER	NY	STORE NPI #
3	3382835	OTHER	NY	STORE NABP #
4	018639	OTHER	NY	NYS LISCENSE #

General Provider Information

NPI Number	:	1063424208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY LIBERMAN R.PH.

Provider Business Mailing Address
First Line	:	125 SYCAMORE DR
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-2421
Country	:	US
Telephone Number	:	516-484-9009
Fax Number	:	516-625-5469

Provider Business Practice Location Address
First Line	:	15840 CROSSBAY BLVD
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-3136
Country	:	US
Telephone Number	:	718-738-4343
Fax Number	:	718-845-1420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	03/07/2023

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