Individual
ILYSSA LIBERTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 BARTOL AVE STE 100, RIDLEY PARK, PA 19078-2214
(610) 521-9996
Mailing address
PO BOX 34990, BELFAST, ME 04915-0627
(610) 359-5672
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
08/22/2023
Last updated
04/16/2024
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