Organization
TIEFENBRUNN & FORTIN PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA WARREN (OFFICE MANAGER)
(732) 390-8400
Entity
Organization
Contact information
Practice address
503 CRANBURY RD, EAST BRUNSWICK, NJ 08816-3612
(732) 390-8400
Mailing address
503 CRANBURY RD, EAST BRUNSWICK, NJ 08816-3612
(732) 390-8400
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MA047770
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26NJ00146700
NJ STATE LICENSE
NJ
01
—
MA047770
LICENSE NUMBER
NJ
01
—
MA055583
LICENSE NUMBER
NJ
01
—
MA069507
LICENSE NUMBER
NJ
Enumeration date
04/14/2008
Last updated
03/15/2017
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