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NPI Code Detail

MEDICARE: MR. JEROME LOUIS LIBERATORE MSPT

MEDICARE: MR. JEROME LOUIS LIBERATORE MSPT
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
1225100000XPhysical Therapist006222CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12747830OTHERAETNA
22V5870OTHERHEALTH NET FACILITY #
337901OTHERORTHONET CIGNA GRP #
4P2122523OTHEROXFORD
59906497OTHERCIGNA GROUP #

General Provider Information

NPI Number : 1083600688
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEROME LOUIS LIBERATORE MSPT
Provider Business Mailing Address
First Line : 181 MAIN ST
Second Line : PETER S ZIELINSKI PHYSICAL THERAPY PC
City : MONROE
State : CT
Zip : 06468-1110
Country : US
Telephone Number : 203-445-9843
Fax Number : 203-445-9847
Provider Business Practice Location Address
First Line : 181 MAIN ST
Second Line : PETER S ZIELINSKI PHYSICAL THERAPY PC
City : MONROE
State : CT
Zip : 06468-1110
Country : US
Telephone Number : 203-445-9843
Fax Number : 203-445-9847
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 07/08/2007

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1669665840 — MRS. CHRISTINA R CYLWIK PT
Practice Location Address:
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06468-1110
Practice Phone: 203-445-9843
Practice Fax: 203-445-9847

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