Provider Demographics
NPI:1407346604
Name:LIBERTY LABS LLC
Entity Type:Organization
Organization Name:LIBERTY LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIORGIANNI
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:954-200-2053
Mailing Address - Street 1:1700 NW 65TH AVE STE 13
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-4558
Mailing Address - Country:US
Mailing Address - Phone:954-900-2285
Mailing Address - Fax:
Practice Address - Street 1:1700 NW 65TH AVE STE 13
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-4558
Practice Address - Country:US
Practice Address - Phone:954-900-2285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory