Provider Demographics
NPI:1497448567
Name:LIBERTY ORTHOTICS, INC.
Entity Type:Organization
Organization Name:LIBERTY ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:516-326-6786
Mailing Address - Street 1:1201 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-5052
Mailing Address - Country:US
Mailing Address - Phone:516-326-6786
Mailing Address - Fax:516-326-6784
Practice Address - Street 1:1201 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-5052
Practice Address - Country:US
Practice Address - Phone:516-326-6786
Practice Address - Fax:516-326-6784
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIBERTY ORTHOTICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies