Provider Demographics
NPI:1700396108
Name:NIEDERMAN, BRYAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:NIEDERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 WHITE ROCK RD UNIT 2106
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1638
Mailing Address - Country:US
Mailing Address - Phone:973-760-3857
Mailing Address - Fax:
Practice Address - Street 1:127 E MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3005
Practice Address - Country:US
Practice Address - Phone:973-535-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00584300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical