Healthcare Provider Details

I. General information

NPI: 1750219929
Provider Name (Legal Business Name): VIDA CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2185 LEMOINE AVE STE 1B
FORT LEE NJ
07024-6030
US

IV. Provider business mailing address

2185 LEMOINE AVE STE 1B
FORT LEE NJ
07024-6030
US

V. Phone/Fax

Practice location:
  • Phone: 201-351-9430
  • Fax:
Mailing address:
  • Phone: 201-351-9430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVID M BRAVERMAN
Title or Position: CEO
Credential:
Phone: 201-351-9430