Healthcare Provider Details

I. General information

NPI: 1811924087
Provider Name (Legal Business Name): DOUGLAS J. TIBURZI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DOUG J. TIBURZI PA-C

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 LAKEHURST RD STE 101
TOMS RIVER NJ
08755-8063
US

IV. Provider business mailing address

530 LAKEHURST RD STE 101
TOMS RIVER NJ
08755-8063
US

V. Phone/Fax

Practice location:
  • Phone: 732-349-8454
  • Fax: 732-341-0259
Mailing address:
  • Phone: 732-349-8454
  • Fax: 732-341-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMP00205
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00020500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: