MEDICARE: LIBERTY MEDICAL ORTHOPEDIC SUPPLIES, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1932266749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY MEDICAL ORTHOPEDIC SUPPLIES, INC.

Provider Business Mailing Address
First Line	:	194 CYPRESS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4438
Country	:	US
Telephone Number	:	718-484-4000
Fax Number	:	718-484-1516

Provider Business Practice Location Address
First Line	:	194 CYPRESS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4438
Country	:	US
Telephone Number	:	718-484-4000
Fax Number	:	718-484-1516

Authorized Official
Title or Position	:	VP
Name	:	MS. MALVINA GELMAN
Credential	:	C.PED
Telephone Number	:	718-484-4000

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	08/22/2020

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