Provider Demographics
NPI:1992003057
Name:SIVIO-LIEBERMAN, LINA A (PA-C)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:A
Last Name:SIVIO-LIEBERMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINA
Other - Middle Name:A
Other - Last Name:SIVIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:16 PARK PLACE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007
Mailing Address - Country:US
Mailing Address - Phone:347-843-8657
Mailing Address - Fax:347-843-7838
Practice Address - Street 1:245 E 84TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2973
Practice Address - Country:US
Practice Address - Phone:212-235-1692
Practice Address - Fax:212-235-1693
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014633363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP01662767OtherMEDICARE RAILROAD
NYP01662767OtherMEDICARE RAILROAD