Healthcare Provider Details

I. General information

NPI: 1245212299
Provider Name (Legal Business Name): TIMOTHY LEE FAULER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MAIN ST
HOOSICK FALLS NY
12090-2001
US

IV. Provider business mailing address

3 MAIN ST P.O. BOX 579
HOOSICK FALLS NY
12090-2001
US

V. Phone/Fax

Practice location:
  • Phone: 518-686-0286
  • Fax: 518-686-1412
Mailing address:
  • Phone: 518-686-0286
  • Fax: 518-686-1412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN005676
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: