Tierra Medical LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

TIERRA MEDICAL LLC

Practice address

831 Main Ave
Passaic, NJ 07055-8400

Phone

(862) 249-1333

Fax

(844) 892-1555

NPI assigned

Jul 19, 2020

Last updated

Sep 14, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Fridman

Title

Owner

Phone

(215) 847-2929

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1595116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600041600000",
    "number": "1477161172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "831 MAIN AVE",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070558400",
            "telephone_number": "215-847-2929",
            "fax_number": "844-892-1555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 MAIN AVE",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070558400",
            "telephone_number": "862-249-1333",
            "fax_number": "844-892-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIERRA MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-19",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "status": "A",
        "authorized_official_last_name": "FRIDMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-847-2929"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.