Provider Demographics
NPI:1861491581
Name:LIBERMAN, TARA A (DO)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:A
Last Name:LIBERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:600 COMMUNITY DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:516-823-8010
Mailing Address - Fax:516-823-8108
Practice Address - Street 1:600 COMMUNITY DR
Practice Address - Street 2:SUITE 304
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-823-8010
Practice Address - Fax:516-823-8108
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2009-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY231331207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI30964Medicare UPIN
NY5YP0Y1Medicare ID - Type Unspecified