Healthcare Provider Details

I. General information

NPI: 1578269056
Provider Name (Legal Business Name): DR. CHRISTOPHER T TIKUM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CENTRAL AVE
EAST ORANGE NJ
07018-2819
US

IV. Provider business mailing address

270 11TH AVE
NEWARK NJ
07103-1303
US

V. Phone/Fax

Practice location:
  • Phone: 973-266-8400
  • Fax:
Mailing address:
  • Phone: 973-819-8786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01436400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: