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Individual
LARRY J TIEFENBRUNN
Active
Individual
LARRY J TIEFENBRUNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
MA047770
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0070672
QUALCARE/GHI ID NY
NJ
01
—
202433
UNITED ID
NJ
01
—
F06243
HEALTHNET ID
NJ
01
—
MA047770
HIP/PHCS
NJ
01
—
P2676479
OXFORD
NJ
Enumeration date
03/15/2006
Last updated
03/15/2017
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