Active NPI
Olivia Liberatore
- Speech-Language Pathologist
- Bronx, NY
National Provider Identifier
1790048288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 0228227-1
- Practice address
- 750 Baychester Ave
Bronx, NY 10475-1701 - Phone
- (718) 904-5400
- NPI assigned
- Jun 19, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 2335306 | NY | |
| Speech-Language Pathologist | 235Z00000X | 0228227-1 | NY | Primary |
Addresses
Primary practice location
750 Baychester Ave
Bronx, NY 10475-1701
Mailing address
750 Baychester Ave
Bronx, NY 10475-1701
Phone (718) 904-5400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2335306 | NY | MD | Specialist |
| 0228227-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726185600000",
"number": "1790048288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "750 BAYCHESTER AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104751701",
"telephone_number": "718-904-5400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "750 BAYCHESTER AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104751701",
"telephone_number": "718-904-5400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIBERATORE",
"first_name": "OLIVIA",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-06-19",
"last_updated": "2024-09-13",
"certification_date": "2024-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "2335306",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "0228227-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.