Timothy J Sullivan

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

25 Hollywood Ave
Emerson, NJ 07630-1709

Phone

(201) 245-7109

NPI assigned

Mar 25, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1235989096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 HOLLYWOOD AVE",
            "city": "EMERSON",
            "state": "NJ",
            "postal_code": "076301709",
            "telephone_number": "201-245-7109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 HOLLYWOOD AVE",
            "city": "EMERSON",
            "state": "NJ",
            "postal_code": "076301709",
            "telephone_number": "201-245-7109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "TIMOTHY",
        "middle_name": "J",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-03-25",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philip A. Spagnesi, D.D.S.
• Speech Success
• Anat Spiero
• Strong Start Pediatric Therapy
• Jaclyn Emma Sullivan, NP-C
• Summit Medical Group PA
• Peter Svider, MD
• Sylva A. Takvorian, M.D.
• Tsering Dolma Tamang, FNP
• Michael Tekelly, LPC

• Student in an Organized Health Care Education/Training Program in Emerson, NJ
• Providers in Emerson, NJ by specialty
• Student in an Organized Health Care Education/Training Program in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.