Provider Demographics
NPI:1629303722
Name:MORRIS A TILSON MD PA
Entity Type:Organization
Organization Name:MORRIS A TILSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:TILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-703-0600
Mailing Address - Street 1:14-23 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1240
Mailing Address - Country:US
Mailing Address - Phone:201-703-0600
Mailing Address - Fax:
Practice Address - Street 1:14-23 RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1240
Practice Address - Country:US
Practice Address - Phone:201-703-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA39153207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ460013Medicare UPIN