Healthcare Provider Details

I. General information

NPI: 1659532232
Provider Name (Legal Business Name): TIMOTHY WILLIAM DEYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 E 72ND ST STE 103
NEW YORK NY
10021-4028
US

IV. Provider business mailing address

519 E 72ND ST STE 103
NEW YORK NY
10021-4028
US

V. Phone/Fax

Practice location:
  • Phone: 212-288-1575
  • Fax: 212-288-7716
Mailing address:
  • Phone: 212-288-1575
  • Fax: 212-288-7716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number226291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: