Healthcare Provider Details

I. General information

NPI: 1144432113
Provider Name (Legal Business Name): JOSEPH M TINER CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

880 KENNEDY BLVD
BAYONNE NJ
07002-5809
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-3586
  • Fax: 908-522-5750
Mailing address:
  • Phone: 201-455-5035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: