Provider Demographics
NPI:1003905498
Name:GJENVICK, TIMOTHY C (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:GJENVICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3521
Mailing Address - Country:US
Mailing Address - Phone:609-924-9300
Mailing Address - Fax:609-430-9481
Practice Address - Street 1:1600 PERRINEVILLE RD
Practice Address - Street 2:
Practice Address - City:MONROE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08831-4923
Practice Address - Country:US
Practice Address - Phone:609-924-9300
Practice Address - Fax:609-430-9451
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03470600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ162296OtherAMERIHLTH ADMIN-PCP
NJ2647154OtherAETNA HMO&NON HMO-PCP
NJ249681OtherUNITEDE HEALTHCARE-PCP
NJLS403OtherOXFORD-PCP
NJ110246529OtherRAILROAD MED-PRINCETON
NJ0085740000OtherAMERIHEALTH/IBC-PCP
NJ110244288OtherRAILROAD MED.-MONROE
NJ3150305Medicaid
NJLS403OtherOXFORD-PCP
NJ110246529OtherRAILROAD MED-PRINCETON