MEDICARE: LIBERTY WOMEN OB/GYN PC

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	261QM2500X	Medical Specialty Clinic/Center	25MA 07533400	NJ

General Provider Information

NPI Number	:	1932334224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY WOMEN OB/GYN PC

Provider Business Mailing Address
First Line	:	377 JERSEY AVENUE
Second Line	:	SUITE 250
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4396
Country	:	US
Telephone Number	:	201-763-6763
Fax Number	:	201-763-6774

Provider Business Practice Location Address
First Line	:	377 JERSEY AVENUE
Second Line	:	SUITE 250
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4396
Country	:	US
Telephone Number	:	201-763-6763
Fax Number	:	201-763-6774

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AHMED S. YOUSRY
Credential	:	M.D., FACOG
Telephone Number	:	201-763-6763

Provider Enumeration Date	:	05/15/2009
Last Update Date	:	04/24/2014

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