Provider Demographics
NPI:1770767089
Name:TANZMAN, JEFFREY MARC (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARC
Last Name:TANZMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3449
Mailing Address - Country:US
Mailing Address - Phone:732-985-0700
Mailing Address - Fax:732-985-0701
Practice Address - Street 1:1716 HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3449
Practice Address - Country:US
Practice Address - Phone:732-985-0700
Practice Address - Fax:732-985-0701
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00199200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3301401Medicaid
NJ462193Medicare PIN