Healthcare Provider Details

I. General information

NPI: 1114942240
Provider Name (Legal Business Name): TIMOTHY L. MURRY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAY AVE
MONTCLAIR NJ
07042-4837
US

IV. Provider business mailing address

340 GROVE ST 3A
JERSEY CITY NJ
07302-5905
US

V. Phone/Fax

Practice location:
  • Phone: 973-429-6250
  • Fax:
Mailing address:
  • Phone: 704-905-5611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number086637
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: