Basic Information
| Provider Information | |||||||||
| NPI: | 1770083511 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BITTERLICH | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | ANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 E. NEW YORK AVENUE | ||||||||
| Address2: | SPG 4TH FL ADMIN OFFICE | ||||||||
| City: | SOMERS POINT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096533265 | ||||||||
| FaxNumber: | 6099264311 | ||||||||
| Practice Location | |||||||||
| Address1: | 9710 VENTOR AVENUE | ||||||||
| Address2: | |||||||||
| City: | MARGATE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098224800 | ||||||||
| FaxNumber: | 6098222617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2018 | ||||||||
| LastUpdateDate: | 02/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | 26NR15592000 | NJ | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.