Healthcare Provider Details

I. General information

NPI: 1639236276
Provider Name (Legal Business Name): LIBERTY FOOT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 BROADWAY
BAYONNE NJ
07002
US

IV. Provider business mailing address

PO BOX 3279
BAYONNE NJ
07002
US

V. Phone/Fax

Practice location:
  • Phone: 201-858-4900
  • Fax:
Mailing address:
  • Phone: 201-858-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1963
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1963
License Number StateMN

VIII. Authorized Official

Name: KHALED H ELMASRY
Title or Position: BOARD CERTIFIED PEDORTHIST
Credential: C PED
Phone: 201-858-4900