MEDICARE: DR. LORI TIERNO RICHWINE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	25MB05512100	NJ
2	207Q00000X	Family Medicine Physician	MB55121	NJ

General Provider Information

NPI Number	:	1518015783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI TIERNO RICHWINE D.O.

Provider Business Mailing Address
First Line	:	3110 OCEAN HEIGHTS AVE
Second Line	:	STE 1
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-7734
Country	:	US
Telephone Number	:	609-927-9555
Fax Number	:	609-926-8902

Provider Business Practice Location Address
First Line	:	3110 OCEAN HEIGHTS AVE
Second Line	:	STE 1
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-7734
Country	:	US
Telephone Number	:	609-927-9555
Fax Number	:	609-926-8902

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2007
Last Update Date	:	10/17/2019

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