Provider Demographics
NPI:1235885195
Name:SHOREY, TIMOTHY MARK
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MARK
Last Name:SHOREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 ROSEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-5238
Mailing Address - Country:US
Mailing Address - Phone:732-551-4143
Mailing Address - Fax:
Practice Address - Street 1:1001 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:PA
Practice Address - Zip Code:19076-1307
Practice Address - Country:US
Practice Address - Phone:732-551-4143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral