MEDICARE: DR. MIRIAM S LIBKIND 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	207N00000X	Dermatology Physician	225963	NY
2	207NS0135X	Procedural Dermatology Physician	225963	NY

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	:	1679572978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIRIAM S LIBKIND M.D.

Provider Business Mailing Address
First Line	:	949 CENTRAL AVE
Second Line	:	SUITE 101
City	:	WOODMERE
State	:	NY
Zip	:	11598-1204
Country	:	US
Telephone Number	:	516-295-1921
Fax Number	:	516-295-9304

Provider Business Practice Location Address
First Line	:	949 CENTRAL AVE
Second Line	:	SUITE 101
City	:	WOODMERE
State	:	NY
Zip	:	11598-1204
Country	:	US
Telephone Number	:	516-295-1921
Fax Number	:	516-295-9304

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	03/27/2013

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