Organization
LIBERTY HEALTH SUPPLY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA KOZAK (OFFICE MANAGER)
(585) 235-1370
Entity
Organization
Contact information
Practice address
1099 JAY ST, SUITE E, ROCHESTER, NY 14611-1153
(585) 235-1370
(585) 235-1385
Mailing address
1099 JAY ST, SUITE E, ROCHESTER, NY 14611-1153
(585) 235-1370
(585) 235-1385
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02068413
—
NY
01
—
103644
PREFERRED CARE PROVIDER #
NY
05
—
1302050
—
RI
01
—
8201631
EVERCARE
NY
01
—
LHE109146
EXCELLUS PROVIDER #
NY
01
—
P0170059CM
BLUE CHOICE PROVIDER #
NY
Enumeration date
05/09/2006
Last updated
10/07/2019
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