Individual
TIFFANY LO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
201 LYONS AVE, NEWARK, NJ 07112-2027
(973) 926-7000
Mailing address
201 LYONS AVE, NEWARK, NJ 07112-2027
(917) 607-9855
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
018260
NY
363AS0400X
Surgical Physician Assistant
Primary
25MP00527700
NJ
Other
Enumeration date
12/04/2014
Last updated
11/03/2022
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