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General NPI Number Information
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NPI Number | 1750874277
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Entity Type | Individual
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Provider Name | KRYSTAL MARIE MC TIGHE MD
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Gender | Female
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Dates
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Enumeration Date | 06/09/2018
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 495 JACK MARTIN BLVD STE 5
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City | BRICK
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State | NJ
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Zip | 08724-7778
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Country | US
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Telephone | 732-458-8000
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Fax | 732-458-8020
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Provider Business Mailing Address
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Address Line | 205 E LAKE DR
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City | GOLDSBORO
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State | NC
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Zip | 27534-6387
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Country | US
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Telephone | 973-897-7264
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2019046477
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA12590900
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License Number State | NJ
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