Provider Demographics
NPI:1093127912
Name:LIBERTY HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:LIBERTY HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ZEPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-528-2080
Mailing Address - Street 1:700 E GATE DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3803
Mailing Address - Country:US
Mailing Address - Phone:856-266-9239
Mailing Address - Fax:856-840-0873
Practice Address - Street 1:700 E GATE DR
Practice Address - Street 2:SUITE 115
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3803
Practice Address - Country:US
Practice Address - Phone:856-266-9239
Practice Address - Fax:856-840-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0103704251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJHP0103704OtherHEALTHCARE SERVICE FIRM LICENSE