Provider Demographics
NPI:1245212299
Name:FAULER, TIMOTHY LEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LEE
Last Name:FAULER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MAIN ST
Mailing Address - Street 2:P.O. BOX 579
Mailing Address - City:HOOSICK FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12090-2001
Mailing Address - Country:US
Mailing Address - Phone:518-686-0286
Mailing Address - Fax:518-686-1412
Practice Address - Street 1:3 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOOSICK FALLS
Practice Address - State:NY
Practice Address - Zip Code:12090-2001
Practice Address - Country:US
Practice Address - Phone:518-686-0286
Practice Address - Fax:518-686-1412
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005676213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02090715Medicaid
NY02090715Medicaid
NYCC0522Medicare PIN