Provider Demographics
NPI:1184784191
Name:LIBERATORE, BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:LIBERATORE
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 1:18 ASHFORD AVE
Mailing Address - Street 2:SUITE 2M
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-1823
Mailing Address - Country:US
Mailing Address - Phone:914-693-8228
Mailing Address - Fax:914-693-8230
Practice Address - Street 1:18 ASHFORD AVE
Practice Address - Street 2:SUITE 2M
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1823
Practice Address - Country:US
Practice Address - Phone:914-693-8228
Practice Address - Fax:914-693-8230
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY133924207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY47D431Medicare ID - Type Unspecified
NYB14989Medicare UPIN