Healthcare Provider Details

I. General information

NPI: 1447849765
Provider Name (Legal Business Name): BRAD SAMUEL LIEBERMAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 11/29/2025
Certification Date: 11/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 N CENTRAL AVE LOWR LEVEL
RAMSEY NJ
07446-1864
US

IV. Provider business mailing address

46 N CENTRAL AVE LOWR LEVEL
RAMSEY NJ
07446-1864
US

V. Phone/Fax

Practice location:
  • Phone: 201-314-1760
  • Fax: 949-561-4843
Mailing address:
  • Phone: 201-314-1760
  • Fax: 949-561-4843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407830
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: