Provider Demographics
NPI:1740273663
Name:LIBERTY REHABILITATION ASSOCIATES
Entity type:Organization
Organization Name:LIBERTY REHABILITATION ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR OF GROP
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAYORAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-392-3231
Mailing Address - Street 1:PO BOX 345
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07474-0345
Mailing Address - Country:US
Mailing Address - Phone:201-392-3231
Mailing Address - Fax:201-392-3207
Practice Address - Street 1:55 MEADOWLANDS PKWY
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2977
Practice Address - Country:US
Practice Address - Phone:201-392-3231
Practice Address - Fax:201-392-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA068155208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty