Organization
LIBERTY MEDICAL, LLC
Active
Parent organization
LIBERTY MEDICAL HOLDINGS, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIBERTY MEDICAL HOLDINGS, LLC
Authorized official
JONATHAN BLACK (PRESIDENT)
(772) 398-2122
Entity
Organization
Contact information
Practice address
958 E 2ND ST, BROOKLYN, NY 11230-2610
(866) 204-7940
(844) 363-4341
Mailing address
8881 S US HIGHWAY 1, ATTN: LICENSING DEPARTMENT, PORT ST LUCIE, FL 34952-3401
(772) 398-2122
(844) 363-4341
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00262506
—
NY
Enumeration date
01/31/2006
Last updated
03/22/2018
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