MEDICARE: LISA ANN LIBERATORE, MD, PC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1356593412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA ANN LIBERATORE, MD, PC

Provider Business Mailing Address
First Line	:	154 E 85TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-2168
Country	:	US
Telephone Number	:	212-288-2222
Fax Number	:	212-288-8084

Provider Business Practice Location Address
First Line	:	154 E 85TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-2168
Country	:	US
Telephone Number	:	212-288-2222
Fax Number	:	212-288-8084

Authorized Official
Title or Position	:	PRESIDENT/DIRECTOR
Name	:	LISA ANN LIBERATORE
Credential	:	M.D.
Telephone Number	:	212-288-2222

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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