Provider Demographics
NPI:1104195767
Name:TIMOTHY J. HAYES, DC, PA
Entity Type:Organization
Organization Name:TIMOTHY J. HAYES, DC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-577-9700
Mailing Address - Street 1:800 W MAIN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2554
Mailing Address - Country:US
Mailing Address - Phone:732-577-9700
Mailing Address - Fax:732-577-9790
Practice Address - Street 1:800 W MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2554
Practice Address - Country:US
Practice Address - Phone:732-577-9700
Practice Address - Fax:732-577-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00265700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT04550Medicare UPIN
NJ416264Medicare PIN