NPIMap

Organization Active NPI

Liberty Child and Adolescent Health Services

  • Specialist
  • Jersey City, NJ
National Provider Identifier
1003812728
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
LIBERTY CHILD AND ADOLESCENT HEALTH SERVICES
Practice address
550 Newark Ave
Jersey City, NJ 07306-1326
Phone
(201) 714-7902
NPI assigned
Jun 27, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Richard J Bonforte, MDNPI 1447256177
Title
President
Phone
(201) 714-7903

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

550 Newark Ave
Jersey City, NJ 07306-1326

Mailing address

PO Box 334
Wayne, NJ 07474-0334
Phone (201) 804-2800

Other identifiers 1

IdentifierTypeStateIssuer
6697704MedicaidNJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003812728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 334",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074740334",
            "telephone_number": "201-804-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 NEWARK AVE",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073061326",
            "telephone_number": "201-714-7902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY CHILD AND ADOLESCENT HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BONFORTE",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-714-7903",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6697704",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey City, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.