Healthcare Provider Details

I. General information

NPI: 1417771791
Provider Name (Legal Business Name): DIANA LIBMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DEAL RD
OCEAN NJ
07712-3622
US

IV. Provider business mailing address

4 TRUMAN DR
MARLBORO NJ
07746-1128
US

V. Phone/Fax

Practice location:
  • Phone: 732-531-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37AC00653200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: