Healthcare Provider Details

I. General information

NPI: 1215922653
Provider Name (Legal Business Name): J. TIMOTHY SENSOR ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2284 OLD FARM RD
SCOTCH PLAINS NJ
07076-2157
US

IV. Provider business mailing address

2284 OLD FARM RD
SCOTCH PLAINS NJ
07076-2157
US

V. Phone/Fax

Practice location:
  • Phone: 908-889-5990
  • Fax:
Mailing address:
  • Phone: 908-889-5990
  • Fax: 908-737-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00004000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: