Healthcare Provider Details

I. General information

NPI: 1407350499
Provider Name (Legal Business Name): BRACHA LUBART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 09/25/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 GREEN POND RD
ROCKAWAY NJ
07866-4200
US

IV. Provider business mailing address

348 MAIN AVE
CLIFTON NJ
07014-1328
US

V. Phone/Fax

Practice location:
  • Phone: 973-983-9006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02739800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: