Provider Demographics
NPI:1942254156
Name:EUSTACE, TIMOTHY JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:EUSTACE
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 1:106 W PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1336
Mailing Address - Country:US
Mailing Address - Phone:201-843-3111
Mailing Address - Fax:201-843-3111
Practice Address - Street 1:106 W PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1336
Practice Address - Country:US
Practice Address - Phone:201-843-3111
Practice Address - Fax:201-843-3111
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2011000Medicaid
NJ2011000Medicaid
NJT45484Medicare UPIN