Provider Demographics
NPI:1205836772
Name:LIBERMAN, JEFFREY A (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:LIBERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:485 TITUS AVE
Mailing Address - Street 2:STE H
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3535
Mailing Address - Country:US
Mailing Address - Phone:585-544-5368
Mailing Address - Fax:585-278-5304
Practice Address - Street 1:485 TITUS AVE
Practice Address - Street 2:STE H
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3535
Practice Address - Country:US
Practice Address - Phone:585-544-5368
Practice Address - Fax:585-278-5304
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY206490-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01821498Medicaid
NY101701BJOtherPREFERRED CARE
NYP010206490OtherEXCELLUS BC/BS
NY01821498Medicaid
NYP010206490OtherEXCELLUS BC/BS