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General NPI Number Information
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NPI Number | 1780141762
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Entity Type | Individual
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Provider Name | TIFFANY KENDIG PT
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Gender | Female
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 1199 PLEASANT VALLEY WAY
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City | WEST ORANGE
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State | NJ
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Zip | 07052-1424
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Country | US
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Telephone | 201-207-8501
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 WALL ST W STE 200
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City | LYNDHURST
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State | NJ
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Zip | 07071-3615
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Country | US
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Telephone | 201-207-8501
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 025100
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01776400
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License Number State | NJ
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