Organization
LIBERTY CHILD AND ADOLESCENT HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD J BONFORTE MD (PRESIDENT)
(201) 714-7903
Entity
Organization
Contact information
Practice address
550 NEWARK AVE, JERSEY CITY, NJ 07306-1326
(201) 714-7902
Mailing address
PO BOX 334, WAYNE, NJ 07474-0334
(201) 804-2800
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6697704
—
NJ
Enumeration date
06/27/2005
Last updated
08/22/2020
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