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General NPI Number Information
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NPI Number | 1184683088
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Entity Type | Individual
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Provider Name | MARIA TENEBRUSO PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 9 POST RD STE M5
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City | OAKLAND
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State | NJ
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Zip | 07436-1615
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Country | US
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Telephone | 201-327-0220
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Fax | 201-327-4871
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Provider Business Mailing Address
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Address Line | 728 LAFAYETTE ST
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City | PARAMUS
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State | NJ
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Zip | 07652-2345
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Country | US
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Telephone | 201-445-3336
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00101200
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License Number State | NJ
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