Healthcare Provider Details

I. General information

NPI: 1316155195
Provider Name (Legal Business Name): ALLAN TIMON ASUNTO RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 WOOLLEY DR
NEPTUNE NJ
07753-3870
US

IV. Provider business mailing address

516 WOOLLEY DR
NEPTUNE NJ
07753-3870
US

V. Phone/Fax

Practice location:
  • Phone: 848-333-5609
  • Fax:
Mailing address:
  • Phone: 848-333-5609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number027970
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: