Provider Demographics
NPI:1932334224
Name:LIBERTY WOMEN OB/GYN PC
Entity Type:Organization
Organization Name:LIBERTY WOMEN OB/GYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:S
Authorized Official - Last Name:YOUSRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACOG
Authorized Official - Phone:201-763-6763
Mailing Address - Street 1:377 JERSEY AVENUE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4396
Mailing Address - Country:US
Mailing Address - Phone:201-763-6763
Mailing Address - Fax:201-763-6774
Practice Address - Street 1:377 JERSEY AVENUE
Practice Address - Street 2:SUITE 250
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4396
Practice Address - Country:US
Practice Address - Phone:201-763-6763
Practice Address - Fax:201-763-6774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA 07533400261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty