Healthcare Provider Details

I. General information

NPI: 1770529075
Provider Name (Legal Business Name): TASMIN LEE CORDIE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 01/16/2022
Certification Date: 01/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 STATE ROUTE 79 N STE 8
MORGANVILLE NJ
07751-2079
US

IV. Provider business mailing address

242 STATE ROUTE 79 N STE 8
MORGANVILLE NJ
07751-2079
US

V. Phone/Fax

Practice location:
  • Phone: 732-443-0300
  • Fax: 732-526-4150
Mailing address:
  • Phone: 732-443-0300
  • Fax: 732-526-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC009093
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: