Healthcare Provider Details

I. General information

NPI: 1356182356
Provider Name (Legal Business Name): TIRZAH ABITTAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 MORRIS AVE
SPRINGFIELD NJ
07081-1151
US

IV. Provider business mailing address

41 WESTGATE RD APT F
TEANECK NJ
07666-5023
US

V. Phone/Fax

Practice location:
  • Phone: 973-379-2111
  • Fax:
Mailing address:
  • Phone: 201-245-2498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF05240588
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: