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General NPI Number Information
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NPI Number | 1811064926
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Entity Type | Organization
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Legal Business Name | LIBERTY MEDICAL PRATICE P.C
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11501 LIBERTY AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-1901
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Country | US
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Telephone | 718-323-1921
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Fax | 718-323-1922
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Provider Business Mailing Address
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Address Line | 115-01 LIBERTY AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11419
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Country | US
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Telephone | 718-323-1921
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Fax | 718-323-1922
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Authorized Official
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Title or Position | DIRECTOR
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Name | SALAH M. MOHAMED
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Credential | P.T
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Telephone | 71832321921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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