Individual
KENNETH TIETJEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2601 OCEAN PKWY, BROOKLYN, NY 11235-7745
(718) 616-3205
Mailing address
2601 OCEAN PKWY RM 901, BROOKLYN, NY 11235-7745
(718) 616-3205
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
307219
NY
Other
Enumeration date
04/20/2017
Last updated
08/25/2021
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