Provider Demographics
NPI:1861574279
Name:LIBBY, JOSEPH ANTHONY (MD, FACP, CMD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:LIBBY
Suffix:
Gender:
Credentials:MD, FACP, CMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 FUTURE WAY
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4490
Mailing Address - Country:US
Mailing Address - Phone:689-207-0654
Mailing Address - Fax:407-396-1028
Practice Address - Street 1:1663 FUTURE WAY
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4490
Practice Address - Country:US
Practice Address - Phone:689-207-0654
Practice Address - Fax:407-396-1028
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME148336207R00000X
NJMA58280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00887089OtherRAILROAD MEDICARE (PALMETTO)
NJ6310001Medicaid
0742942000OtherAMERIHEALTH
F92922Medicare UPIN
NJ6310001Medicaid