Healthcare Provider Details

I. General information

NPI: 1346683802
Provider Name (Legal Business Name): CHERRY PIE TIU APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 NEW RD STE 1
NORTHFIELD NJ
08225-1179
US

IV. Provider business mailing address

1418 NEW RD STE 1
NORTHFIELD NJ
08225-1179
US

V. Phone/Fax

Practice location:
  • Phone: 609-798-7969
  • Fax: 866-493-0370
Mailing address:
  • Phone: 609-796-7969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00429800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ00429800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00429800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: