Provider Demographics
NPI:1467449264
Name:SORENSEN, TIMOTHY J (DPM)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:SORENSEN
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 1:33 E MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2219
Mailing Address - Country:US
Mailing Address - Phone:609-465-9094
Mailing Address - Fax:609-463-8349
Practice Address - Street 1:33 E MECHANIC ST
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2219
Practice Address - Country:US
Practice Address - Phone:609-465-9094
Practice Address - Fax:609-463-8349
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00190300213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5055380001Medicare NSC
NJU24033Medicare UPIN
NJ696438Medicare PIN