Healthcare Provider Details

I. General information

NPI: 1750347647
Provider Name (Legal Business Name): TENAFLY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 FRANKLIN ST TENAFLY PEDIATRICS
TENAFLY NJ
07670-2005
US

IV. Provider business mailing address

32 FRANKLIN ST TENAFLY PEDIATRICS
TENAFLY NJ
07670-2005
US

V. Phone/Fax

Practice location:
  • Phone: 201-569-2400
  • Fax: 201-816-0136
Mailing address:
  • Phone: 201-569-2400
  • Fax: 201-816-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: TOM ZEUG
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 201-569-2400