1083654503 NPI number — LIBERTY ORTHOTICS, INC.

Table of content: (NPI 1083654503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083654503 NPI number — LIBERTY ORTHOTICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIBERTY ORTHOTICS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083654503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 2ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11040-4925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-326-6786
Provider Business Mailing Address Fax Number:
516-326-6784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 2ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11040-4925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-326-6786
Provider Business Practice Location Address Fax Number:
516-326-6784
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRANDT
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
XAVIER
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
516-326-6786

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000023042 . This is a "AFFINITY PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3125 . This is a "NY PRESBYTERIAN SELECT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02010093 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000412358262 . This is a "HEALTH PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 04072200123 . This is a "FIDELIS HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1211801 . This is a "COMMUNITY PREMIER PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2021095 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4C4927 . This is a "HEALTH NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10532 . This is a "HUDSON HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 57P0182 . This is a "ABC HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10093592 . This is a "CDPHP PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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