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General NPI Number Information
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NPI Number | 1700396108
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Entity Type | Individual
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Provider Name | BRYAN NIEDERMAN PHD
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Gender | Male
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 10/11/2017
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Provider Practice Location Address
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Address Line | 127 E MOUNT PLEASANT AVE
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City | LIVINGSTON
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State | NJ
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Zip | 07039-3005
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Country | US
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Telephone | 973-535-8555
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Fax |
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Provider Business Mailing Address
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Address Line | 220 WHITE ROCK RD UNIT 2106
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City | VERONA
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State | NJ
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Zip | 07044-1638
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Country | US
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Telephone | 973-760-3857
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35SI00584300
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License Number State | NJ
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