Provider Demographics
NPI:1770637928
Name:SARACENO, LIBERO (MD)
Entity Type:Individual
Prefix:DR
First Name:LIBERO
Middle Name:
Last Name:SARACENO
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:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:137 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1712
Practice Address - Country:US
Practice Address - Phone:973-344-5379
Practice Address - Fax:973-344-1988
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04303700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ336530-1Medicaid
SA536663Medicare ID - Type Unspecified
NJ336530-1Medicaid