Liberty Physical Medicine & Rehab

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

241442 Issued in NY

Legal business name

LIBERTY PHYSICAL MEDICINE & REHAB

Practice address

3755 77TH St
Suite 1J
Jackson Heights, NY 11372-6603

Phone

(718) 651-8414

NPI assigned

Aug 13, 2010

Last updated

Aug 13, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Elyse Chang

Title

Office Manager

Phone

(718) 651-8414

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1281657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281657600000",
    "number": "1780999755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3755 77TH ST",
            "address_2": "SUITE 1J",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113726603",
            "telephone_number": "718-651-8414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3755 77TH ST",
            "address_2": "SUITE 1J",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113726603",
            "telephone_number": "718-651-8414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY PHYSICAL MEDICINE & REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-13",
        "last_updated": "2010-08-13",
        "status": "A",
        "authorized_official_last_name": "CHANG",
        "authorized_official_first_name": "ELYSE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "718-651-8414"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "241442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luisa Ebanks Levitt, SLP
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• Steven Licardi, LCSW
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• Physical Medicine & Rehabilitation Physician in Jackson Heights, NY
• Providers in Jackson Heights, NY by specialty
• Physical Medicine & Rehabilitation Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2010; 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.