MEDICARE: DR. DEBORA KOGAN-LIBERMAN MD

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	2080P0206X	Pediatric Gastroenterology Physician	25MA06234800	NJ
2	2080P0206X	Pediatric Gastroenterology Physician	003487-1	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	:	1972544054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORA KOGAN-LIBERMAN MD

Provider Business Mailing Address
First Line	:	111 E 210TH ST
Second Line	:	ROSENTHAL 3
City	:	BRONX
State	:	NY
Zip	:	10467-2401
Country	:	US
Telephone Number	:	718-741-2332
Fax Number	:	718-515-5426

Provider Business Practice Location Address
First Line	:	3415 BAINBRIDGE AVE FL 4
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2403
Country	:	US
Telephone Number	:	718-741-2332
Fax Number	:	718-515-5426

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	10/09/2025

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