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NPI Code Detail

MEDICARE: MRS. NAOMI TIEFENBRUNN

MEDICARE: MRS. NAOMI TIEFENBRUNN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician25MP00210700NY
2363A00000XPhysician Assistant25MP00221700NJ

General Provider Information

NPI Number : 1932346194
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NAOMI TIEFENBRUNN
Provider Business Mailing Address
First Line : 1771 MADISON AVE
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-1242
Country : US
Telephone Number : 732-364-2144
Fax Number :
Provider Business Practice Location Address
First Line : 1771 MADISON AVE
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-1242
Country : US
Telephone Number : 732-364-2144
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2009
Last Update Date : 04/28/2023

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