NYSARC INC MONTGOMERY COUNTY CHAPTER LIBERTY

Provider Demographics

• NPI: 1376902734
• Name: NYSARC INC MONTGOMERY COUNTY CHAPTER LIBERTY
• Entity Type: Organization
• Organization Name: NYSARC INC MONTGOMERY COUNTY CHAPTER LIBERTY
• Other - Org Name: LIBERTY ENTERPRISES
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: CEO
• Authorized Official - Prefix: MS
• Authorized Official - First Name: JENNIFER
• Authorized Official - Last Name: SAUNDERS
• Authorized Official - Phone: 518-954-3223
• Mailing Address - Street 1: 43 LIBERTY DR
• Mailing Address - City: AMSTERDAM
• Mailing Address - State: NY
• Mailing Address - Zip Code: 12010-5635
• Mailing Address - Country: US
• Mailing Address - Phone: 518-954-3346
• Mailing Address - Fax: 518-954-3308
• Practice Address - Street 1: 47 LIBERTY DR
• Practice Address - City: AMSTERDAM
• Practice Address - State: NY
• Practice Address - Zip Code: 12010
• Practice Address - Country: US
• Practice Address - Phone: 518-954-2027
• Practice Address - Fax: 518-954-2009
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: NYSARC INC
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2016-02-15
• Last Update Date: 2016-06-07

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	261QM1300X	Ambulatory Health Care Facilities	Clinic/Center	Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NY	00644606	Medicaid
NY	02621043	Medicaid
NY	02247652	Medicaid
NY	02700049	Medicaid
NY	03588281	Medicaid
NY	01494471	Medicaid
NY	02171800	Medicaid
NY	02247698	Medicaid
NY	02416264	Medicaid
NY	02245476	Medicaid
NY	02714189	Medicaid
NY	02599411	Medicaid
NY	02061801	Medicaid
NY	02617792	Medicaid
NY	01385217	Medicaid
NY	01750518	Medicaid
NY	02002115	Medicaid
NY	02924252	Medicaid