Healthcare Provider Details

I. General information

NPI: 1972509792
Provider Name (Legal Business Name): LIBERTY ANESTHESIA ASSOCIATES, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 REECEVILLE RD
COATESVILLE PA
19320-1542
US

IV. Provider business mailing address

PO BOX 8500-1776
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 215-949-5327
  • Fax:
Mailing address:
  • Phone: 201-804-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JAY S FINEMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 215-291-3000