Provider Demographics
NPI:1275799843
Name:ABDULLAH, TIFFANY A (PT)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:A
Last Name:ABDULLAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:A
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:136 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08880-1337
Mailing Address - Country:US
Mailing Address - Phone:201-874-4070
Mailing Address - Fax:
Practice Address - Street 1:136 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08880-1337
Practice Address - Country:US
Practice Address - Phone:201-874-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01089400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist