Organization Active NPI

Lisa Ann Liberatore, MD, PC

  • Specialist
  • New York, NY
National Provider Identifier
1356593412
Registry record updated Oct 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
LISA ANN LIBERATORE, MD, PC
Practice address
154 E 85TH St
New York, NY 10028-2168
Phone
(212) 288-2222
Fax
(212) 288-8084
NPI assigned
Oct 21, 2008
Last updated
Oct 21, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lisa Ann Liberatore, M.D.NPI 1871562934
Title
President/Director
Phone
(212) 288-2222

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

154 E 85TH St
New York, NY 10028-2168

Mailing address

154 E 85TH St
New York, NY 10028-2168
Phone (212) 288-2222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090428000199 NY Part B Supplier - Clinic/Group Practice 9931257151 Receives reassigned benefits from 4 practitioners
Practice locations: New York, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224547200000",
    "number": "1356593412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 E 85TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100282168",
            "telephone_number": "212-288-2222",
            "fax_number": "212-288-8084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 E 85TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100282168",
            "telephone_number": "212-288-2222",
            "fax_number": "212-288-8084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA ANN LIBERATORE, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-21",
        "last_updated": "2008-10-21",
        "status": "A",
        "authorized_official_last_name": "LIBERATORE",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT/DIRECTOR",
        "authorized_official_telephone_number": "212-288-2222",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.