Provider Demographics
NPI:1811924087
Name:TIBURZI, DOUGLAS J (PA-C)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:J
Last Name:TIBURZI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:DOUG
Other - Middle Name:J
Other - Last Name:TIBURZI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:530 LAKEHURST ROAD
Mailing Address - Street 2:STE 101
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8063
Mailing Address - Country:US
Mailing Address - Phone:732-349-8454
Mailing Address - Fax:732-341-0259
Practice Address - Street 1:530 LAKEHURST ROAD
Practice Address - Street 2:STE 101
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8063
Practice Address - Country:US
Practice Address - Phone:732-349-8454
Practice Address - Fax:732-341-0259
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP00205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery