Healthcare Provider Details

I. General information

NPI: 1023019312
Provider Name (Legal Business Name): TIMOTHY PILLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 W RED BANK AVE SUITE 203
WOODBURY NJ
08096-1630
US

IV. Provider business mailing address

2 EVES DR SUITE 109
MARLTON NJ
08053-3193
US

V. Phone/Fax

Practice location:
  • Phone: 856-848-8242
  • Fax: 856-384-6015
Mailing address:
  • Phone: 856-669-6061
  • Fax: 856-651-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA05024600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA05024600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: