Provider Demographics
NPI:1023214483
Name:DI LIBERTO, ANTHONY R (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:R
Last Name:DI LIBERTO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CHRISTOPHER COLUMBUS DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-5526
Mailing Address - Country:US
Mailing Address - Phone:201-474-8464
Mailing Address - Fax:
Practice Address - Street 1:115 CHRISTOPHER COLUMBUS DR
Practice Address - Street 2:SUITE 402
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-5526
Practice Address - Country:US
Practice Address - Phone:201-474-8464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU74718Medicare UPIN
NJ026036Medicare ID - Type Unspecified