Provider Demographics
NPI:1124545751
Name:LIFECARE MEDICAL OFFICE, PC
Entity Type:Organization
Organization Name:LIFECARE MEDICAL OFFICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOLANTA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LIBURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:646-382-7742
Mailing Address - Street 1:6514 BEACH FRONT RD
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1293
Mailing Address - Country:US
Mailing Address - Phone:646-382-7742
Mailing Address - Fax:646-417-5002
Practice Address - Street 1:6514 BEACH FRONT RD
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1293
Practice Address - Country:US
Practice Address - Phone:646-382-7742
Practice Address - Fax:646-417-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty