Provider Demographics
NPI:1205190535
Name:LIBURA, JOLANTA JULIA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOLANTA
Middle Name:JULIA
Last Name:LIBURA
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253330282N00000X, 207R00000X
NY271516282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No282N00000XHospitalsGeneral Acute Care Hospital