Healthcare Provider Details

I. General information

NPI: 1093402018
Provider Name (Legal Business Name): TIMOTHY JAMES WENZEL JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W MAIN ST STE 305B
FREEHOLD NJ
07728-2537
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 732-462-0100
  • Fax: 732-462-0348
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA12980700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: