Provider Demographics
NPI:1932346194
Name:TIEFENBRUNN, NAOMI
Entity Type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:
Last Name:TIEFENBRUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:
Other - Last Name:SARFATY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1771 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1242
Mailing Address - Country:US
Mailing Address - Phone:732-364-2144
Mailing Address - Fax:
Practice Address - Street 1:1771 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1242
Practice Address - Country:US
Practice Address - Phone:732-364-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25MP00210700208000000X
NJ25MP00221700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208000000XAllopathic & Osteopathic PhysiciansPediatrics