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General NPI Number Information
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NPI Number | 1750596607
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Entity Type | Individual
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Provider Name | JORDAN LIEBERMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | UCHC C/O NJ DOC, WHITTLESEY RD & STUYVESANT AVE BATES BUILDING, 2ND FLOOR
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City | TRENTON
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State | NJ
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Zip | 08625-0863
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Country | US
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Telephone | 609-292-9700
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Fax |
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Provider Business Mailing Address
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Address Line | UCHC C/O NJ DOC, WHITTLESEY RD & STUYVESANT AVE BATES BUILDING, 2ND FLOOR
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City | TRENTON
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State | NJ
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Zip | 08625-0863
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Country | US
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Telephone | 609-292-9700
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD044764L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA05925300
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License Number State | NJ
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