Provider Demographics
NPI:1033311147
Name:LIBERT, MELISSA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MARIE
Last Name:LIBERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:657 WILLOW GROVE ST
Mailing Address - Street 2:STE 401
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1868
Mailing Address - Country:US
Mailing Address - Phone:908-850-7800
Mailing Address - Fax:908-850-7802
Practice Address - Street 1:3 SCHOOL ST STE 302
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2548
Practice Address - Country:US
Practice Address - Phone:516-759-1234
Practice Address - Fax:516-674-9172
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2016-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08549000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics