Provider Demographics
NPI:1114745635
Name:LIBERTY PHYSICIAN PARTNERS PC
Entity type:Organization
Organization Name:LIBERTY PHYSICIAN PARTNERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARIZH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:914-460-4891
Mailing Address - Street 1:25 SAVIN CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4215
Mailing Address - Country:US
Mailing Address - Phone:646-898-6734
Mailing Address - Fax:
Practice Address - Street 1:175 MEMORIAL HWY STE 1-1
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5639
Practice Address - Country:US
Practice Address - Phone:914-460-4891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center