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NPI Code Detail

MEDICARE: JORDYN LIEBERMAN PA-C

MEDICARE: JORDYN LIEBERMAN PA-C
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
1363A00000XPhysician AssistantNY

General Provider Information

NPI Number : 1588521363
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDYN LIEBERMAN PA-C
Provider Business Mailing Address
First Line : 230 CEDRUS AVE
Second Line :
City : EAST NORTHPORT
State : NY
Zip : 11731-4515
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1728 SUNRISE HWY
Second Line :
City : MERRICK
State : NY
Zip : 11566-3745
Country : US
Telephone Number : 516-279-3352
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2026
Last Update Date : 01/05/2026

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