Provider Demographics
NPI:1275967192
Name:TEGETHOFF, CYNTHIA (APN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:TEGETHOFF
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7907
Mailing Address - Country:US
Mailing Address - Phone:570-972-4724
Mailing Address - Fax:610-991-7774
Practice Address - Street 1:480 MEMORIAL PKWY UNIT 4
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1575
Practice Address - Country:US
Practice Address - Phone:908-854-3088
Practice Address - Fax:610-991-7774
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00458500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health