Individual provider Active NPI

Malkah Doba Tiefenbrun, DNP

  • Emergency Medicine Physician
  • Elizabeth, NJ
National Provider Identifier
1275293268
Registry record updated Jun 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
26NR19215300 Issued in NJ
Practice address
530 Riverside Dr
Elizabeth, NJ 07208-2117
Phone
(718) 839-5592
NPI assigned
Dec 18, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 26NJ01239100 NJ
Family Nurse Practitioner 363LF0000X F348843-01 NY
Family Nurse Practitioner 363LF0000X 26NJ01239100 NJ
Emergency Medicine Physician 207P00000X 26NR19215300 NJ Primary

Addresses

Primary practice location

530 Riverside Dr
Elizabeth, NJ 07208-2117

Mailing address

530 Riverside Dr
Elizabeth, NJ 07208-2117
Phone (718) 839-5592

Other identifiers 1

IdentifierTypeStateIssuer
0827924MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220207000026 NJ Practitioner - Nurse Practitioner 5597158022 Reassigns benefits to 1 organization
I20250415003303 NY Practitioner - Nurse Practitioner 5597158022 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Middlesex Emergency Physicians, P.a.Group PAC ID 9931002854, 41 clinicians

Practice addresses (Care Compare)

65 James St
Edison, NJ 08818-3903
Phone (732) 321-7000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ01239100NJMDFamily Nurse Practitioner
F348843-01NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Middlesex Emergency Physicians, P.a. Emergency Medicine CurrentSince Feb 1, 2022 Accepting new patients
Weill Medical College of Cornell CurrentSince Jan 19, 2025 Accepting new patients
Weill Medical College of Cornell CurrentSince Jan 19, 2025 Accepting new patients

Locations

65 James St
Edison, NJ 08820
Phone (732) 321-7010

G Po 26521
New York, NY 10087

170 William St
New York, NY 10038
Phone (212) 238-0100

525 E 68th St
New York, NY 10065
Phone (212) 746-2846

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686268800000",
    "number": "1275293268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 RIVERSIDE DR",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072082117",
            "telephone_number": "718-839-5592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 RIVERSIDE DR",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072082117",
            "telephone_number": "718-839-5592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIEFENBRUN",
        "first_name": "MALKAH",
        "middle_name": "DOBA",
        "name_prefix": "Dr.",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-18",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "26NJ01239100",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F348843-01",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ01239100",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "26NR19215300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0827924",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth, NJ

Sources for this page

Verify at the official NPI Registry.