MEDICARE: MISS JENNIFER DENISE LIBURD 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	174400000X	Specialist	201137	NY
2	208000000X	Pediatrics Physician	201137	NY

General Provider Information

NPI Number	:	1730117797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JENNIFER DENISE LIBURD M.D.

Provider Business Mailing Address
First Line	:	19 LANDAU LN
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-1826
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9002 QUEENS BLVD
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-4941
Country	:	US
Telephone Number	:	718-558-5711
Fax Number	:

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	05/15/2023

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