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General NPI Number Information
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NPI Number | 1699509778
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Entity Type | Individual
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Provider Name | TIMOTHY GILLIN FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 08/29/2024
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 450 LAKEVILLE RD STE M42
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1117
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Country | US
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Telephone | 516-734-8500
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Fax | 516-734-8535
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Provider Business Mailing Address
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Address Line | 450 LAKEVILLE RD STE M42
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1117
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Country | US
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Telephone | 516-734-8500
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Fax | 516-734-8535
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F353477-01
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License Number State | NY
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