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General NPI Number Information
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NPI Number | 1720058456
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Entity Type | Individual
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Provider Name | TARA LYNN TIMMERMAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 184 E 70TH ST SUITE B2
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City | NEW YORK
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State | NY
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Zip | 10021-5154
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Country | US
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Telephone | 212-737-4174
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Fax | 212-737-3392
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Provider Business Mailing Address
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Address Line | 522 E 82ND ST APT. #5
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City | NEW YORK
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State | NY
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Zip | 10028-7118
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Country | US
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Telephone | 212-737-4174
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Fax | 212-737-3392
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 214284
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License Number State | NY
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