Liberty Medical, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

LIBERTY MEDICAL, LLC

Practice address

89 Main Street
Suite 204
Milford, MA 01757-3141

Phone

(866) 202-2420

Fax

(844) 363-4341

NPI assigned

Oct 11, 2005

Organization subpart

Yes

Parent organization

LIBERTY MEDICAL HOLDINGS, LLCAs reported in NPPES

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

Authorized official

Name

Jonathan Black

Title

President

Phone

(772) 398-2122

Specialties & licenses 1

Addresses

Other identifiers 4

Tax ID family

Liberty Medical LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Neighborhood Diabetes, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Orlando, FL
  • NPI 1871759118
  NPD tax ID

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Insulet Corporation

  • Durable Medical Equipment & Medical Supplies
  • Acton, MA
  • NPI 1013914027

  Member Of

  NPD member
• Liberty Medical, LLC

  • Durable Medical Equipment & Medical Supplies
  • Brooklyn, NY
  • NPI 1467423079

  Member Of

  NPD member

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Liberty Medical, LLC

  • Durable Medical Equipment & Medical Supplies
  • Brooklyn, NY
  • NPI 1467423079

  Member Of

  NPD member

Locations

Practitioners 1

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

• Elvira Quiroga Johnson, M.S.,R.D.,C.D.E.,LDN

  • Registered Dietitian
  • Woburn, MA
  • NPI 1407949043
  NPD (past)

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521763200000",
    "number": "1609864990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8881 S US HIGHWAY 1",
            "address_2": "ATTN: LICENSING DEPARTMENT",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349523401",
            "telephone_number": "772-398-2122",
            "fax_number": "844-363-4341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 MAIN STREET",
            "address_2": "SUITE 204",
            "city": "MILFORD",
            "state": "MA",
            "postal_code": "017573141",
            "telephone_number": "866-202-2420",
            "fax_number": "844-363-4341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY MEDICAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIBERTY MEDICAL HOLDINGS, LLC",
        "enumeration_date": "2005-10-11",
        "last_updated": "2018-03-23",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "772-398-2122"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30703422",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110020874E",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1557308-01",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1024762540001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donna Li
• Xiangyang Li, MD, PHD
• Zhongzhen Li, M.D.
• Haisun Liao, MD
• Sharon Libbin, M.S., CCC-A
• Sara Libiszewski
• Katherine Liebfried
• Katie Helen Lima
• Mark Amthony Lima
• Kristen Jane Liming

• Durable Medical Equipment & Medical Supplies in Milford, MA
• Providers in Milford, MA by specialty
• Durable Medical Equipment & Medical Supplies in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2018; 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.