Healthcare Provider Details

I. General information

NPI: 1235478033
Provider Name (Legal Business Name): TIKIKIL FIRDU M.D., M.P.H
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIKIKIL FIRDU BETRU

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 FRANKLIN CORNER RD SUITE 214
LAWRENCEVILLE NJ
08648-2526
US

IV. Provider business mailing address

1 BENJAMIN CT
PRINCETON JUNCTION NJ
08550-3307
US

V. Phone/Fax

Practice location:
  • Phone: 609-896-1400
  • Fax:
Mailing address:
  • Phone: 609-317-5174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA09448900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: