Provider Demographics
NPI:1396858387
Name:BROMBERG, DANIEL S (PHD, ABPP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:BROMBERG
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HERITAGE WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-4827
Mailing Address - Country:US
Mailing Address - Phone:973-537-8084
Mailing Address - Fax:
Practice Address - Street 1:315 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2745
Practice Address - Country:US
Practice Address - Phone:973-366-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI004033103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist