Active NPI
Timothy J Corey, MD
- Dermatology Physician
- Ridgewood, NJ
National Provider Identifier
1235234949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- MA35733
- Practice address
- 400 Route 17 South
Ridgewood, NJ 07450 - Phone
- (201) 652-4536
- Fax
- (201) 652-4906
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | MA35733 | NJ | Primary |
Addresses
Primary practice location
400 Route 17 South
Ridgewood, NJ 07450
Mailing address
400 Route 17 South
Ridgewood, NJ 07450
Phone (201) 652-4536
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0428604 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA35733 | NJ | MD | Dermatology Physician |
Interoperability endpoints
- timothy.corey.1@24719.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1235234949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 ROUTE 17 SOUTH",
"city": "RIDGEWOOD",
"state": "NJ",
"postal_code": "07450",
"telephone_number": "201-652-4536",
"fax_number": "201-652-4906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 ROUTE 17 SOUTH",
"city": "RIDGEWOOD",
"state": "NJ",
"postal_code": "07450",
"telephone_number": "201-652-4536",
"fax_number": "201-652-4906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COREY",
"first_name": "TIMOTHY",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "NJ",
"license": "MA35733",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0428604",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ridgewood, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.