1922818434 NPI number — TIFFANIE KURTZ EDS, PSYD

Table of content: TIFFANIE KURTZ EDS, PSYD (NPI 1922818434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922818434 NPI number — TIFFANIE KURTZ EDS, PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KURTZ
Provider First Name:
TIFFANIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
EDS, PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSATI
Provider Other First Name:
TIFFANIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922818434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
96 BATAAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TINTON FALLS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07724-3212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-890-9357
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 IRON BRIDGE RD STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREEHOLD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07728-5305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-920-3434
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2025

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: 103T00000X , with the licence number:  243-028 , 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)