Provider Demographics
NPI:1679572978
Name:LIBKIND, MIRIAM S (MD)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:S
Last Name:LIBKIND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:949 CENTRAL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1204
Mailing Address - Country:US
Mailing Address - Phone:516-295-1921
Mailing Address - Fax:516-295-9304
Practice Address - Street 1:949 CENTRAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1204
Practice Address - Country:US
Practice Address - Phone:516-295-1921
Practice Address - Fax:516-295-9304
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225963207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02762412Medicaid
NY02762412Medicaid
NYI25983Medicare UPIN