Provider Demographics
NPI:1003950676
Name:LENGLE, TIMOTHY ROBERT (MA, ATC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ROBERT
Last Name:LENGLE
Suffix:
Gender:M
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 GREENWAY AVE
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2756
Mailing Address - Country:US
Mailing Address - Phone:609-434-0108
Mailing Address - Fax:
Practice Address - Street 1:2083 LAWRENCEVILLE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-3001
Practice Address - Country:US
Practice Address - Phone:609-896-5052
Practice Address - Fax:609-896-5086
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000719002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer