Individual provider Active NPI

John Libertella, D.P.M.

  • Podiatrist
  • Brooklyn, NY
National Provider Identifier
1558453779
Registry record updated Oct 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
N005640 Issued in NY
Practice address
9414 Flatlands Ave
Ste 201 E
Brooklyn, NY 11236-3741
Phone
(718) 649-6464
Fax
(718) 649-6426
NPI assigned
Sep 28, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X N005640 NY Primary

Addresses

Primary practice location

9414 Flatlands Ave
Ste 201 E
Brooklyn, NY 11236-3741

Mailing address

8419 Bay Pkwy
Brooklyn, NY 11214-3303
Phone (718) 331-0200

Other practice location 1

8419 Bay Pkwy
Brooklyn, NY 11214-3303
Phone (718) 331-0200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190703000988 NY Practitioner - Podiatry 3779817242 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
005640NYMDAcupuncturist
N005640NYMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Metropolitan Foot Care PC Podiatrist CurrentSince Feb 27, 2024 Accepting new patients

Locations

9413 Flatlands Ave
Ste 201E
Brooklyn, NY 11236

1409 Gravesend Neck Rd
Brooklyn, NY 11229
Phone (718) 332-7771

4116 Junction Blvd
Corona, NY 11368

24825 Union Tpke
Jamaica, NY 11426
Phone (718) 470-0668

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698105600000",
    "number": "1558453779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8419 BAY PKWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112143303",
            "telephone_number": "718-331-0200",
            "fax_number": "718-331-0893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9414 FLATLANDS AVE",
            "address_2": "STE 201 E",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112363741",
            "telephone_number": "718-649-6464",
            "fax_number": "718-649-6426"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8419 Bay Pkwy",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112143303",
            "country_code": "US",
            "telephone_number": "718-331-0200",
            "fax_number": "718-331-0893",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIBERTELLA",
        "first_name": "JOHN",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NY",
            "license": "N005640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.