Provider Demographics
NPI:1639236276
Name:LIBERTY FOOT CARE INC
Entity Type:Organization
Organization Name:LIBERTY FOOT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED PEDORTHIST
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:H
Authorized Official - Last Name:ELMASRY
Authorized Official - Suffix:
Authorized Official - Credentials:C PED
Authorized Official - Phone:201-858-4900
Mailing Address - Street 1:PO BOX 3279
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002
Mailing Address - Country:US
Mailing Address - Phone:201-858-4900
Mailing Address - Fax:
Practice Address - Street 1:287 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002
Practice Address - Country:US
Practice Address - Phone:201-858-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1963332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment