Provider Demographics
NPI:1053642538
Name:ALLAN D. TIEDRICH, M.D. P.A.
Entity Type:Organization
Organization Name:ALLAN D. TIEDRICH, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TIEDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-769-7999
Mailing Address - Street 1:1304 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07062-1937
Mailing Address - Country:US
Mailing Address - Phone:908-769-7999
Mailing Address - Fax:908-769-5816
Practice Address - Street 1:1304 SOUTH AVEUNE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07062
Practice Address - Country:US
Practice Address - Phone:908-769-7999
Practice Address - Fax:908-769-5816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty