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Individual

MR. FREDERICK R. TIENCKEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
RPA-C

Contact information

Practice address
1200 E RIDGEWOOD AVE STE 200, RIDGEWOOD, NJ 07450-3937
(201) 327-8600
(201) 327-8225
Mailing address
1200 E RIDGEWOOD AVE STE 200, RIDGEWOOD, NJ 07450-3937
(201) 327-8600
(201) 327-8225

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
014271
NY
363AM0700X
Medical Physician Assistant
Primary
25MP00264400
NJ

Other

Enumeration date
09/21/2010
Last updated
08/21/2025
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