Provider Demographics
NPI:1932406352
Name:COREN, TABITHA AIMIE
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:AIMIE
Last Name:COREN
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 1:203 FLORAL VALE BLVD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5524
Mailing Address - Country:US
Mailing Address - Phone:215-968-7600
Mailing Address - Fax:215-968-7609
Practice Address - Street 1:203 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5524
Practice Address - Country:US
Practice Address - Phone:215-968-7600
Practice Address - Fax:215-968-7609
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002576133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered