Provider Demographics
NPI:1073899571
Name:TIM CANTY MD PLLC
Entity Type:Organization
Organization Name:TIM CANTY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-524-7246
Mailing Address - Street 1:11 BLEECKER ST
Mailing Address - Street 2:3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2402
Mailing Address - Country:US
Mailing Address - Phone:617-642-0141
Mailing Address - Fax:
Practice Address - Street 1:101 BROADWAY
Practice Address - Street 2:B02
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-8663
Practice Address - Country:US
Practice Address - Phone:917-524-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237504174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty