Provider Demographics
NPI:1770083511
Name:BITTERLICH, TANYA ANNE
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:ANNE
Last Name:BITTERLICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E. NEW YORK AVENUE
Mailing Address - Street 2:SPG 4TH FL ADMIN OFFICE
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:609-653-3265
Mailing Address - Fax:609-926-4311
Practice Address - Street 1:9710 VENTOR AVENUE
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:NJ
Practice Address - Zip Code:08402
Practice Address - Country:US
Practice Address - Phone:609-822-4800
Practice Address - Fax:609-822-2617
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15592000163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator