Healthcare Provider Details

I. General information

NPI: 1548214075
Provider Name (Legal Business Name): LIBERTY ANESTHESIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W MAIN ST
FREEHOLD NJ
07728-2537
US

IV. Provider business mailing address

901 W MAIN ST
FREEHOLD NJ
07728-2537
US

V. Phone/Fax

Practice location:
  • Phone: 732-294-2875
  • Fax: 732-782-2935
Mailing address:
  • Phone: 732-294-2875
  • Fax: 732-782-2935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: GILBERT L DROZDOW
Title or Position: PRESIDENT
Credential: MD
Phone: 954-838-2371