Contract Details
Facility name
Liberty Orthotics, Inc
Provider ID
P000003773
NPI
1083654503
Tax ID
113453198
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
1201 2nd Ave
New Hyde Park, NY 11040
United States
County
Nassau
Phone
5163266786 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address