Provider Demographics
NPI:1104416601
Name:TIERNEY, MATTHEW PATRICK
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PATRICK
Last Name:TIERNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E LINCOLN AVE
Mailing Address - Street 2:STOP RY34-A3014
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-4646
Mailing Address - Country:US
Mailing Address - Phone:908-740-4000
Mailing Address - Fax:
Practice Address - Street 1:126 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-4646
Practice Address - Country:US
Practice Address - Phone:908-740-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049122969183700000X
1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study
No183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1545220OtherNATIONAL ASSOCIATION OF BOARDS OF PHARMACY