Provider Demographics
NPI:1619308251
Name:LIBERTY MEDICAL OFFICE, P.C.
Entity Type:Organization
Organization Name:LIBERTY MEDICAL OFFICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZABER
Authorized Official - Middle Name:AHMAD
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-752-7058
Mailing Address - Street 1:188 DAHILL RD
Mailing Address - Street 2:SUITE - A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2289
Mailing Address - Country:US
Mailing Address - Phone:718-435-4600
Mailing Address - Fax:718-435-4772
Practice Address - Street 1:530 CONDUIT BLVD
Practice Address - Street 2:SUITE-C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3245
Practice Address - Country:US
Practice Address - Phone:718-277-5500
Practice Address - Fax:718-277-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234133261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02807454Medicaid
A400033174Medicare PIN
NY02807454Medicaid