Provider Demographics
NPI:1265429732
Name:THIERMAN, DAVID H (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:THIERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 PASSAIC AVE
Mailing Address - Street 2:APT 439
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1858
Mailing Address - Country:US
Mailing Address - Phone:800-467-2392
Mailing Address - Fax:812-471-6650
Practice Address - Street 1:849 57TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3797
Practice Address - Country:US
Practice Address - Phone:929-234-3150
Practice Address - Fax:347-955-5976
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0425270002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5396204Medicaid
NY02642675Medicaid
NJ409333Q9EMedicare PIN
NJ5396204Medicaid