Active NPI
Derek Lieberman
- Physician Assistant
- Garden City, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 01749
- Practice address
- 877 Stewart Ave
Garden City, NY 11530-4803 - Phone
- (516) 745-0202
- NPI assigned
- Mar 11, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 01749 | NY | Primary |
Addresses
Primary practice location
877 Stewart Ave
Garden City, NY 11530-4803
Mailing address
544 N Lewis Ave
Lindenhurst, NY 11757-3536
Phone (631) 245-2514
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
300 Community Dr
Manhasset, NY 11030-3816
300 Community Dr LL
Manhasset, NY 11030-3816
Phone (516) 562-2229
330 Community Dr
Manhasset, NY 11030-3816
Phone (516) 708-2550
350 Community Dr
Manhasset, NY 11030-3816
Phone (516) 562-3845
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01749 | NY | MD | Physician Assistant |
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba NHPP Cardiology at Great Neck
- Urology Physician
- Great Neck, NY
- NPI 1053688572
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1394496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1394496000000",
"number": "1144646498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "544 N LEWIS AVE",
"city": "LINDENHURST",
"state": "NY",
"postal_code": "117573536",
"telephone_number": "631-245-2514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "877 STEWART AVE",
"city": "GARDEN CITY",
"state": "NY",
"postal_code": "115304803",
"telephone_number": "516-745-0202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIEBERMAN",
"first_name": "DEREK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-03-11",
"last_updated": "2014-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "01749",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garden City, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.