Healthcare Provider Details

I. General information

NPI: 1205211620
Provider Name (Legal Business Name): JOHN TIMOTHY NOBLE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 01/06/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2649 STRANG BLVD STE 206
YORKTOWN HEIGHTS NY
10598-2938
US

IV. Provider business mailing address

2649 STRANG BLVD STE 206
YORKTOWN HEIGHTS NY
10598-2938
US

V. Phone/Fax

Practice location:
  • Phone: 914-233-3008
  • Fax: 914-233-3011
Mailing address:
  • Phone: 914-233-3008
  • Fax: 914-233-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF307438-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: