Organization
LIBERTY RC INC
Active
Other names
South Brooklyn Nephrology Center
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (ASSISTANT SECRETARY)
(615) 341-6641
Entity
Organization
Contact information
Practice address
3915 AVENUE V, STE 104, BROOKLYN, NY 11234-5156
(718) 252-8440
(718) 252-6490
Mailing address
5200 VIRGINIA WAY, L & C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
1401232R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00698095
—
NY
Enumeration date
12/09/2009
Last updated
12/19/2024
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