Provider Demographics
NPI:1659125185
Name:LIBERTY MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:LIBERTY MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:201-218-8422
Mailing Address - Street 1:146 BREWSTER AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-2229
Mailing Address - Country:US
Mailing Address - Phone:201-218-8422
Mailing Address - Fax:
Practice Address - Street 1:506 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-1432
Practice Address - Country:US
Practice Address - Phone:201-218-8422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care