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General NPI Number Information
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NPI Number | 1295927341
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Entity Type | Individual
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Provider Name | TIMOTHY JOHN PRESTOSH D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 02/13/2020
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Provider Practice Location Address
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Address Line | 1501 LEHIGH ST
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City | ALLENTOWN
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State | PA
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Zip | 18103-3880
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Country | US
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Telephone | 610-628-8380
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Fax |
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Provider Business Mailing Address
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Address Line | 3025 SHAKESPEARE RD
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City | BETHLEHEM
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State | PA
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Zip | 18017-3219
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS014052
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License Number State | PA
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