Provider Demographics
NPI:1841483435
Name:LIEBERMAN, JOY (NUTRITIONIST)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:
Other - Last Name:DECARO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NUTRITIONIST
Mailing Address - Street 1:3 WASHINGTON CTR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-4627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 WASHINGTON CTR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-4627
Practice Address - Country:US
Practice Address - Phone:845-563-8000
Practice Address - Fax:845-565-2968
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL848144133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist