Provider Demographics
NPI:1205185485
Name:MCSORLEY, TIMOTHY JOSEPH (ANP-BC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:MCSORLEY
Suffix:
Gender:M
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5260 LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08344-5217
Mailing Address - Country:US
Mailing Address - Phone:856-694-5437
Mailing Address - Fax:
Practice Address - Street 1:5260 LAKE ROAD
Practice Address - Street 2:
Practice Address - City:NEWFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08344-5217
Practice Address - Country:US
Practice Address - Phone:856-694-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00332700363LA2200X
PASP011365363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health