Provider Demographics
NPI:1164533279
Name:LIEBERMAN, JAY M (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:M
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1605
Mailing Address - Country:US
Mailing Address - Phone:562-933-8750
Mailing Address - Fax:562-997-9634
Practice Address - Street 1:2685 ELM AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1605
Practice Address - Country:US
Practice Address - Phone:562-933-8750
Practice Address - Fax:562-997-9634
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG586292080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases