Healthcare Provider Details

I. General information

NPI: 1841961638
Provider Name (Legal Business Name): TIMOTHY DAVID PADLICK RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 GENESEE ST STE 401
AUBURN NY
13021-3511
US

IV. Provider business mailing address

144 GENESEE ST STE 500
AUBURN NY
13021-3510
US

V. Phone/Fax

Practice location:
  • Phone: 315-253-8477
  • Fax: 315-515-3191
Mailing address:
  • Phone: 315-253-8477
  • Fax: 315-515-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number824083
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: