Provider Demographics
NPI:1972562452
Name:PULEIO, TIFFANY ANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:ANNE
Last Name:PULEIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2931
Mailing Address - Country:US
Mailing Address - Phone:609-597-8498
Mailing Address - Fax:609-597-0571
Practice Address - Street 1:85 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2931
Practice Address - Country:US
Practice Address - Phone:609-597-8498
Practice Address - Fax:609-597-0571
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00966700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066352RC6Medicare ID - Type Unspecified