1316972243 NPI number — MR. TIMOTHY EUGENE VANDYKE PHYSICAL THERAPIST A

Table of content: MR. TIMOTHY EUGENE VANDYKE PHYSICAL THERAPIST A (NPI 1316972243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316972243 NPI number — MR. TIMOTHY EUGENE VANDYKE PHYSICAL THERAPIST A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDYKE
Provider First Name:
TIMOTHY
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST A
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316972243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300A PRINCETON HIGHTSTOWN RD
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
EAST WINDSOR
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08520-1411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-426-4442
Provider Business Mailing Address Fax Number:
609-443-0910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 PRINCETON HIGHTSTOWN ROAD
Provider Second Line Business Practice Location Address:
BUILDING A STE 201
Provider Business Practice Location Address City Name:
EAST WINDSOR
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08520-1411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-426-4442
Provider Business Practice Location Address Fax Number:
609-443-0910
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  40QB00201100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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