Organization
MOBILE MEDICARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS COLLEEN ELIZABETH TIEDEMANN (OFFICE MANAGER)
(732) 388-7300
Entity
Organization
Contact information
Practice address
67 WALNUT AVE, CLARK, NJ 07066-1640
(732) 388-7300
(732) 388-1330
Mailing address
67 WALNUT AVE, CLARK, NJ 07066-1640
(732) 388-7300
(732) 388-1330
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
MB27483
NJ
207QG0300X
Geriatric Medicine (Family Medicine) Physician
MB53933
NJ
207R00000X
Internal Medicine Physician
MB71509
NJ
Other
Enumeration date
08/30/2006
Last updated
08/06/2007
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