MEDICARE: DR. VALERIY LIBMAN DDS

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	1223G0001X	General Practice Dentistry	049435	NY
2	1223G0001X	General Practice Dentistry	22DI02727300	NJ

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

General Provider Information

NPI Number	:	1417952714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VALERIY LIBMAN DDS

Provider Business Mailing Address
First Line	:	4 TRUMAN DR
Second Line	:
City	:	MARLBORO
State	:	NJ
Zip	:	07746-1128
Country	:	US
Telephone Number	:	212-365-4157
Fax Number	:

Provider Business Practice Location Address
First Line	:	2208 GEORGES RD # US130
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-4805
Country	:	US
Telephone Number	:	732-276-4866
Fax Number	:

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	11/07/2021

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