Provider Demographics
NPI:1528107828
Name:SCHREIBER, JEFFREY R (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:SCHREIBER
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:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07451-0652
Mailing Address - Country:US
Mailing Address - Phone:201-419-9983
Mailing Address - Fax:973-341-4123
Practice Address - Street 1:52 WARREN PLACE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:973-427-0397
Practice Address - Fax:973-423-9580
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1298103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0519201Medicaid
443546Medicare ID - Type Unspecified