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General NPI Number Information
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NPI Number | 1992360978
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Entity Type | Individual
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Provider Name | MR. TIMOTHY ALLEN
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Gender | Male
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 1991 BALSLEY RD
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City | SENECA FALLS
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State | NY
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Zip | 13148-6725
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Country | US
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Telephone | 315-539-9229
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 124
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City | ROSE
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State | NY
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Zip | 14542-0124
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Country | US
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Telephone | 315-576-0082
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 024254
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License Number State | NY
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