Provider Demographics
NPI:1811515711
Name:ALLY MEDICAL GROUP LLC
Entity type:Organization
Organization Name:ALLY MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBERATTORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-981-2388
Mailing Address - Street 1:2300 PALM BEACH LAKES BLVD STE 300A
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3300
Mailing Address - Country:US
Mailing Address - Phone:866-981-2388
Mailing Address - Fax:
Practice Address - Street 1:2300 PALM BEACH LAKES BLVD STE 300A
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3300
Practice Address - Country:US
Practice Address - Phone:561-215-5067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies