Healthcare Provider Details

I. General information

NPI: 1972407773
Provider Name (Legal Business Name): LIBERTY SOCIAL ADULT DAYCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 OCEAN PKWY APT 1A
BROOKLYN NY
11235-8035
US

IV. Provider business mailing address

126 WALNUT ST
LYNBROOK NY
11563-2029
US

V. Phone/Fax

Practice location:
  • Phone: 917-519-1151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: REZWAN SIDDIQUE
Title or Position: CEO
Credential:
Phone: 917-519-1151