Provider Demographics
NPI:1447849765
Name:LIEBERMAN, BRAD SAMUEL (NP)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:SAMUEL
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:46 N CENTRAL AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1864
Mailing Address - Country:US
Mailing Address - Phone:201-314-1760
Mailing Address - Fax:949-561-4843
Practice Address - Street 1:46 N CENTRAL AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1864
Practice Address - Country:US
Practice Address - Phone:201-314-1760
Practice Address - Fax:949-561-4843
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01118200363LP0808X, 363L00000X
NY431941363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care