Provider Demographics
NPI:1134489438
Name:TEJERINA, MANFRED (DO)
Entity Type:Individual
Prefix:
First Name:MANFRED
Middle Name:
Last Name:TEJERINA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:MANFRED
Other - Middle Name:
Other - Last Name:TEJERINA TEMMERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:94 OLD SHORT HILLS RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5672
Mailing Address - Country:US
Mailing Address - Phone:973-322-5267
Mailing Address - Fax:973-322-2851
Practice Address - Street 1:688 KINOOLE ST STE 103
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-969-8010
Practice Address - Fax:903-663-7394
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS18912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology