Provider Demographics
NPI:1255455101
Name:LIBERTY MEDICAL BILLING, INC
Entity type:Organization
Organization Name:LIBERTY MEDICAL BILLING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-775-6659
Mailing Address - Street 1:PO BOX 2149
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06813-2149
Mailing Address - Country:US
Mailing Address - Phone:203-775-6659
Mailing Address - Fax:203-775-6692
Practice Address - Street 1:26 HOP BROOK RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-1327
Practice Address - Country:US
Practice Address - Phone:203-775-6659
Practice Address - Fax:203-775-6692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02063505Medicaid