Provider Demographics
NPI:1114928678
Name:BIALECKI, TIMOTHY ALVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALVIN
Last Name:BIALECKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2453
Mailing Address - Country:US
Mailing Address - Phone:732-549-2872
Mailing Address - Fax:732-494-6919
Practice Address - Street 1:276 MAIN ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2453
Practice Address - Country:US
Practice Address - Phone:732-549-2872
Practice Address - Fax:732-494-6919
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00361400111N00000X
PADC-003921-L111N00000X
NY005746111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT87645Medicare UPIN