Provider Demographics
NPI:1467552687
Name:LIBIEN, JENNY M (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:M
Last Name:LIBIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:450 CLARKSON AVE
Mailing Address - Street 2:BOX 1262
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2056
Mailing Address - Country:US
Mailing Address - Phone:718-270-8867
Mailing Address - Fax:718-270-1794
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:BOX 25
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2056
Practice Address - Country:US
Practice Address - Phone:718-270-1279
Practice Address - Fax:718-270-4567
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2009-04-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY226077207ZP0101X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1J6321Medicare PIN