Provider Demographics
NPI:1508866427
Name:TIMPANO, EUGENE VINCENT (DPM)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:VINCENT
Last Name:TIMPANO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WYNNWOOD DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3033
Mailing Address - Country:US
Mailing Address - Phone:856-786-2247
Mailing Address - Fax:856-786-2713
Practice Address - Street 1:1701 WYNNWOOD DR
Practice Address - Street 2:SUITE 4
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3033
Practice Address - Country:US
Practice Address - Phone:856-786-2247
Practice Address - Fax:856-786-2713
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMDO1381213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0273805Medicaid
123425Medicare PIN
NJ0273805Medicaid