Individual
LARRY J TIEFENBRUNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
503 CRANBURY RD, EAST BRUNSWICK, NJ 08816-3612
(732) 390-8400
(732) 390-8970
Mailing address
503 CRANBURY RD, EAST BRUNSWICK, NJ 08816-3612
(732) 390-8400
(732) 390-8970
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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