Healthcare Provider Details

I. General information

NPI: 1518015783
Provider Name (Legal Business Name): LORI TIERNO RICHWINE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2007
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 OCEAN HEIGHTS AVE STE 1
EGG HARBOR TOWNSHIP NJ
08234-7734
US

IV. Provider business mailing address

3110 OCEAN HEIGHTS AVE STE 1
EGG HARBOR TOWNSHIP NJ
08234-7734
US

V. Phone/Fax

Practice location:
  • Phone: 609-927-9555
  • Fax: 609-926-8902
Mailing address:
  • Phone: 609-927-9555
  • Fax: 609-926-8902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number25MB05512100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB55121
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: