Healthcare Provider Details

I. General information

NPI: 1053642538
Provider Name (Legal Business Name): ALLAN D. TIEDRICH, M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 SOUTH AVEUNE
PLAINFIELD NJ
07062
US

IV. Provider business mailing address

1304 SOUTH AVE
PLAINFIELD NJ
07062-1937
US

V. Phone/Fax

Practice location:
  • Phone: 908-769-7999
  • Fax: 908-769-5816
Mailing address:
  • Phone: 908-769-7999
  • Fax: 908-769-5816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ALLAN DON TIEDRICH
Title or Position: DR.TIEDRICH
Credential:
Phone: 908-769-7999