Provider Demographics
NPI:1003260506
Name:ROY, TIMOTHY (RN)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:ROY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-2311
Mailing Address - Country:US
Mailing Address - Phone:631-805-6383
Mailing Address - Fax:631-849-5824
Practice Address - Street 1:47 COBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786-2311
Practice Address - Country:US
Practice Address - Phone:631-805-6383
Practice Address - Fax:631-849-5824
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY689742163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse