Provider Demographics
NPI:1750335253
Name:TIU, EVELYN VENZON (MD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:VENZON
Last Name:TIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1163 ROUTE 37 W STE A1
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-4974
Mailing Address - Country:US
Mailing Address - Phone:732-505-4007
Mailing Address - Fax:732-736-8811
Practice Address - Street 1:1163 ROUTE 37 W STE A1
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-505-4007
Practice Address - Fax:732-736-8811
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07224900207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029424Medicaid
NJ0029424Medicaid
NJ1080867Medicare UPIN