MEDICARE: TIMOTHY HALEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician	216793	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	14-1005	OTHER	NY	INDEPENDENT HEALTH
3	00025112602	OTHER	NY	UNIVERA
4	000526057005	OTHER	NY	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1174588008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY HALEY M.D.

Provider Business Mailing Address
First Line	:	415 TREMONT ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-6135
Country	:	US
Telephone Number	:	716-690-2028
Fax Number	:	716-690-2398

Provider Business Practice Location Address
First Line	:	415 TREMONT ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-6135
Country	:	US
Telephone Number	:	716-690-2028
Fax Number	:	716-690-2398

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	01/18/2011

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