=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609016450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIBERTY HOME HEALTHCARE 2
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2009
-----------------------------------------------------
Last Update Date | 03/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 498 BEACH 20 STREET
-----------------------------------------------------
City | FAR ROCKAWAY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-471-2144
-----------------------------------------------------
Fax | 718-471-4371
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 498 BEACH 20 STREET
-----------------------------------------------------
City | FAR ROCKAWAY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-471-2144
-----------------------------------------------------
Fax | 718-471-4371
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. MALVINA GELMAN
-----------------------------------------------------
Credential | C.PED
-----------------------------------------------------
Telephone | 718-471-2144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------