Provider Demographics
NPI:1972544054
Name:KOGAN-LIBERMAN, DEBORA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:
Last Name:KOGAN-LIBERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 210TH ST
Mailing Address - Street 2:ROSENTHAL 3
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2401
Mailing Address - Country:US
Mailing Address - Phone:718-741-2332
Mailing Address - Fax:718-515-5426
Practice Address - Street 1:3415 BAINBRIDGE AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2403
Practice Address - Country:US
Practice Address - Phone:718-741-2332
Practice Address - Fax:718-515-5426
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA062348002080P0206X
NY003487-12080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03190732Medicaid
H49548Medicare UPIN
NY03190732Medicaid