Provider Demographics
NPI:1235751272
Name:LIBERTY
Entity Type:Organization
Organization Name:LIBERTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOMBARDO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA-CCC A
Authorized Official - Phone:201-498-1207
Mailing Address - Street 1:60 GREGORY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4713
Mailing Address - Country:US
Mailing Address - Phone:201-306-5443
Mailing Address - Fax:
Practice Address - Street 1:60 GREGORY AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4713
Practice Address - Country:US
Practice Address - Phone:201-306-5443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Single Specialty