1285809541 NPI number — STEVEN C TIZIO MD

Table of content: STEVEN C TIZIO MD (NPI 1285809541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285809541 NPI number — STEVEN C TIZIO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIZIO
Provider First Name:
STEVEN
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285809541
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1706 CORLIES AVENUE SUITE 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEPTUNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-775-5005
Provider Business Mailing Address Fax Number:
732-775-0064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
766 SHREWSBURY AVE
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
TINTON FALLS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07724-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-450-1500
Provider Business Practice Location Address Fax Number:
732-450-1555
Provider Enumeration Date:
04/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  25MA09473600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208C00000X , with the licence number: 25MA09473600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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