Provider Demographics
NPI:1952330003
Name:TIMOCHKO, GINA (CRNA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:TIMOCHKO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:LEDERHILGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:375 ENGLE ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1823
Mailing Address - Country:US
Mailing Address - Phone:201-871-6073
Mailing Address - Fax:201-871-0619
Practice Address - Street 1:1 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922
Practice Address - Country:US
Practice Address - Phone:908-277-8872
Practice Address - Fax:908-673-7382
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO11437600367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00196568OtherRAILROAD MEDICARE
NJ077100Medicare ID - Type Unspecified