Provider Demographics
NPI:1932247038
Name:LIBERTY FOOTCARE,PLLC
Entity Type:Organization
Organization Name:LIBERTY FOOTCARE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUI
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMELO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-322-7209
Mailing Address - Street 1:12506 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2234
Mailing Address - Country:US
Mailing Address - Phone:718-322-7209
Mailing Address - Fax:718-322-7210
Practice Address - Street 1:12506 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2234
Practice Address - Country:US
Practice Address - Phone:718-322-7209
Practice Address - Fax:718-322-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005746213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU94257Medicare UPIN
NY05644Medicare ID - Type Unspecified