Provider Demographics
NPI:1083654503
Name:LIBERTY ORTHOTICS, INC.
Entity Type:Organization
Organization Name:LIBERTY ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:516-326-6786
Mailing Address - Street 1:1201 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4925
Mailing Address - Country:US
Mailing Address - Phone:516-326-6786
Mailing Address - Fax:516-326-6784
Practice Address - Street 1:1201 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4925
Practice Address - Country:US
Practice Address - Phone:516-326-6786
Practice Address - Fax:516-326-6784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1000023042OtherAFFINITY PROVIDER NUMBER
NY3125OtherNY PRESBYTERIAN SELECT
NY02010093Medicaid
NY000412358262OtherHEALTH PLUS
NY04072200123OtherFIDELIS HEALTH PLANS
NY1211801OtherCOMMUNITY PREMIER PLUS
NY2021095OtherAETNA PROVIDER NUMBER
NY4C4927OtherHEALTH NET
NY10532OtherHUDSON HEALTH PLAN
NY57P0182OtherABC HEALTH PLANS
NY10093592OtherCDPHP PROVIDER #
NY57P0182OtherABC HEALTH PLANS
NY=========01Other1199 NATIONAL BENEFITS FU
NY=========OtherUNITED HEALTHCARE
NY000412358262OtherHEALTH PLUS