Provider Demographics
NPI:1225492002
Name:USLAR, LIUBOU (MD)
Entity Type:Individual
Prefix:DR
First Name:LIUBOU
Middle Name:
Last Name:USLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LIUBOU
Other - Middle Name:
Other - Last Name:RUSAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD PHD
Mailing Address - Street 1:1275 YORK AVE
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:212-639-2000
Mailing Address - Fax:
Practice Address - Street 1:2500 E HALLANDALE BEACH BLVD STE 611
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4839
Practice Address - Country:US
Practice Address - Phone:617-712-6539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY299879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program