Provider Demographics
NPI:1811176415
Name:BRAVER, VANITA (MD)
Entity type:Individual
Prefix:DR
First Name:VANITA
Middle Name:
Last Name:BRAVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 VALLEY ROAD
Mailing Address - Street 2:PO BOX 825
Mailing Address - City:LIBERTY CORNER
Mailing Address - State:NJ
Mailing Address - Zip Code:07938
Mailing Address - Country:US
Mailing Address - Phone:973-856-5330
Mailing Address - Fax:877-408-0145
Practice Address - Street 1:25 BROADWAY RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5055
Practice Address - Country:US
Practice Address - Phone:973-856-5330
Practice Address - Fax:877-408-0145
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA064864002084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7411804Medicaid
NJG62579Medicare UPIN
BR002773Medicare Oscar/Certification