Individual provider Active NPI

Jennifer Denise Liburd, M.D.

  • Pediatrics Physician
  • Elmhurst, NY
National Provider Identifier
1730117797
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
201137 Issued in NY
Practice address
9002 Queens Blvd
Elmhurst, NY 11373-4941
Phone
(718) 558-5711
NPI assigned
Jun 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 201137 NY
Pediatrics Physician 208000000X 201137 NY Primary

Addresses

Primary practice location

9002 Queens Blvd
Elmhurst, NY 11373-4941

Mailing address

19 Landau LN
Spring Valley, NY 10977-1826

Other names 1

  • Jennifer Denise Liburd Other name

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060227000537 NY Practitioner - Pediatric Medicine 6507872686 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Bronxcare Health System CurrentSince Jan 14, 2011 Accepting new patients
Montefiore Medical Center CurrentSince Apr 15, 2017 Accepting new patients
Montefiore Medical Center Emergency Medicine CurrentSince Apr 15, 2017 Accepting new patients
Bronxcare Health System Emergency Medicine CurrentSince Jan 14, 2011 Accepting new patients
Caritas Emergency Medical Services, PC Emergency Medicine Past Accepting new patients
Suny Health Science Center at Brooklyn Emergency Medicine Past Accepting new patients
Beth Israel Medical Center Emergency Medicine Past Accepting new patients
Caritas Emergency Medical Services, PC Emergency Medicine Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

1650 Grand Concourse
#C
Bronx, NY 10457
Phone (718) 294-7104

1650 Grand Concourse
Bronx, NY 10457
Phone (718) 294-7104

160 N Midland Ave
Nyack, NY 10960
Phone (845) 348-2000

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684108800000",
    "number": "1730117797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 LANDAU LN",
            "city": "SPRING VALLEY",
            "state": "NY",
            "postal_code": "109771826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9002 QUEENS BLVD",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113734941",
            "telephone_number": "718-558-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBURD",
        "first_name": "JENNIFER",
        "middle_name": "DENISE",
        "name_prefix": "Miss",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-29",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "201137",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "201137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "LIBURD",
            "middle_name": "DENISE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Elmhurst, NY

Sources for this page

Verify at the official NPI Registry.