MEDICARE: LIBERTY ORTHOTICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1000023042	OTHER	NY	AFFINITY PROVIDER NUMBER
2	3125	OTHER	NY	NY PRESBYTERIAN SELECT
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000412358262	OTHER	NY	HEALTH PLUS
5	04072200123	OTHER	NY	FIDELIS HEALTH PLANS
6	1211801	OTHER	NY	COMMUNITY PREMIER PLUS
7	2021095	OTHER	NY	AETNA PROVIDER NUMBER
8	4C4927	OTHER	NY	HEALTH NET
9	10532	OTHER	NY	HUDSON HEALTH PLAN
10	57P0182	OTHER	NY	ABC HEALTH PLANS
11	10093592	OTHER	NY	CDPHP PROVIDER #

General Provider Information

NPI Number	:	1083654503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY ORTHOTICS, INC.

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

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

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. FRANCIS XAVIER BRANDT SR.
Credential	:
Telephone Number	:	516-326-6786

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	08/22/2020

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