MEDICARE: LIBERTY HEALTH SUPPLY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332BN1400X	Nursing Facility Supplies (DME)
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	335E00000X	Prosthetic/Orthotic Supplier
4	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	LHE109146	OTHER	NY	EXCELLUS PROVIDER #
3	8201631	OTHER	NY	EVERCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	103644	OTHER	NY	PREFERRED CARE PROVIDER #
6	P0170059CM	OTHER	NY	BLUE CHOICE PROVIDER #

General Provider Information

NPI Number	:	1902855729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY HEALTH SUPPLY, INC

Provider Business Mailing Address
First Line	:	1099 JAY ST
Second Line	:	SUITE E
City	:	ROCHESTER
State	:	NY
Zip	:	14611-1153
Country	:	US
Telephone Number	:	585-235-1370
Fax Number	:	585-235-1385

Provider Business Practice Location Address
First Line	:	1099 JAY ST
Second Line	:	SUITE E
City	:	ROCHESTER
State	:	NY
Zip	:	14611-1153
Country	:	US
Telephone Number	:	585-235-1370
Fax Number	:	585-235-1385

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. LISA KOZAK
Credential	:
Telephone Number	:	585-235-1370

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	10/07/2019

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Directions to “LIBERTY HEALTH SUPPLY, INC ” Practice Location

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