MEDICARE: DR. EDWARD LIBFELD M.D.

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	2085N0700X	Neuroradiology Physician	256207-1	NY

General Provider Information

NPI Number	:	1649410416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD LIBFELD M.D.

Provider Business Mailing Address
First Line	:	4705 CENTER BLVD
Second Line	:	APT 2914
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5740
Country	:	US
Telephone Number	:	774-239-1150
Fax Number	:

Provider Business Practice Location Address
First Line	:	4705 CENTER BLVD
Second Line	:	APT 2914
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5740
Country	:	US
Telephone Number	:	774-239-1150
Fax Number	:

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

Provider Enumeration Date	:	03/05/2009
Last Update Date	:	06/27/2010

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