Provider Demographics
NPI:1700950482
Name:LIBERTY HEALTH JERSY CITY MEDICAL CENTER
Entity Type:Organization
Organization Name:LIBERTY HEALTH JERSY CITY MEDICAL CENTER
Other - Org Name:CTR FOR CHILDREN & SPECIAL NEEDS
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WM
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-915-2059
Mailing Address - Street 1:953 GARFIELD AVENUE
Mailing Address - Street 2:CENTER FOR CHILDREN & SPECIAL NEEDS
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304
Mailing Address - Country:US
Mailing Address - Phone:201-915-2059
Mailing Address - Fax:201-915-2551
Practice Address - Street 1:953 GARFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304
Practice Address - Country:US
Practice Address - Phone:201-915-2059
Practice Address - Fax:201-915-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA015848002080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0525901Medicaid
NJ0525901Medicaid