Liberty RC Inc

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

LIBERTY RC INC

Doing business as

Hertel Avenue Dialysis

Practice address

699 Hertel Ave
Ste 380
Buffalo, NY 14207-2355

Phone

(716) 871-4172

Fax

(716) 447-0230

NPI assigned

Apr 10, 2017

Organization subpart

No

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

Authorized official

Name

John D Winstel

Title

Chief Accounting Officer

Phone

(253) 733-4501

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Hertel Avenue Dialysis Doing business as

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

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605484800000",
    "number": "1245763804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L & C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-341-6410",
            "fax_number": "888-662-8259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "699 HERTEL AVE",
            "address_2": "STE 380",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142072355",
            "telephone_number": "716-871-4172",
            "fax_number": "716-447-0230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY RC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-10",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-4501"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04945837",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hertel Avenue Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hertel Avenue Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberly Libera
• Heidi Sue Liberatore, LMT
• Christina Lynn Liberta, M.S.ED.,CCC-SLP
• Amberlee Libertone, DNP, FNP
• Liberty Communications Inc (Liberty Medicar Inc,Liberty Cab)
• Wendy Liberty
• Charles W Librera
• Michael Licata, MD
• Christa Louise Licht, FNP
• Joey Carl Lichtenberger, RPH

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Buffalo, NY
• Providers in Buffalo, NY by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 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.