Healthcare Provider Details

I. General information

NPI: 1063423937
Provider Name (Legal Business Name): BRETT J LIEBERMAN N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 BERNIE OROURKE DR
MIDDLETOWN CT
06457-2510
US

IV. Provider business mailing address

87 BERNIE OROURKE DR
MIDDLETOWN CT
06457-2510
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-8600
  • Fax: 860-347-8434
Mailing address:
  • Phone: 860-347-8600
  • Fax: 860-347-8434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1422
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: