Provider Demographics
NPI:1720051196
Name:LIBERMAN, MICHAEL JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAY
Last Name:LIBERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 E EVESHAM RD STE 302
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4503
Mailing Address - Country:US
Mailing Address - Phone:856-770-1313
Mailing Address - Fax:856-770-1297
Practice Address - Street 1:722 MANTUA PIKE
Practice Address - Street 2:SUITE 8
Practice Address - City:WOODBURY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08097-1141
Practice Address - Country:US
Practice Address - Phone:856-384-1333
Practice Address - Fax:856-384-1297
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00391400111N00000X
PADC004373L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ623823Medicare ID - Type Unspecified
NJU05267Medicare UPIN