Healthcare Provider Details

I. General information

NPI: 1942373675
Provider Name (Legal Business Name): LIBERTY MEDICAL PRACTICE P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2848 CHURCH AVE
BROOKLYN NY
11226-4106
US

IV. Provider business mailing address

2848 CHURCH AVE
BROOKLYN NY
11226-4106
US

V. Phone/Fax

Practice location:
  • Phone: 718-941-2200
  • Fax: 718-703-0872
Mailing address:
  • Phone: 718-941-2200
  • Fax: 718-703-0872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SALAH MOHAMED III
Title or Position: DIRECTOR
Credential:
Phone: 718-859-8808