Healthcare Provider Details

I. General information

NPI: 1023216025
Provider Name (Legal Business Name): YAFFA LIEBERMANN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 LAUREL AVE
KEANSBURG NJ
07734-1125
US

IV. Provider business mailing address

11 MALKE DR
OCEAN NJ
07712-3370
US

V. Phone/Fax

Practice location:
  • Phone: 732-787-8100
  • Fax:
Mailing address:
  • Phone: 732-859-9640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number40QA00370600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: