Provider Demographics
NPI:1467521039
Name:LIBERTY HEALTH CARE SYSTEM
Entity Type:Organization
Organization Name:LIBERTY HEALTH CARE SYSTEM
Other - Org Name:CTR FOR CHILDREN WITH SPECIAL NEEDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-915-2059
Mailing Address - Street 1:115 VANDERVEER AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2540
Mailing Address - Country:US
Mailing Address - Phone:201-915-2079
Mailing Address - Fax:201-915-2551
Practice Address - Street 1:953 GARFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304
Practice Address - Country:US
Practice Address - Phone:201-915-2059
Practice Address - Fax:201-915-2551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIBERTY HEALTH CARE SYSYTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities