Provider Demographics
NPI:1376879213
Name:MCCUE, TIMOTHY P (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:P
Last Name:MCCUE
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CLEMENS CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-1563
Mailing Address - Country:US
Mailing Address - Phone:607-733-4783
Mailing Address - Fax:607-733-6037
Practice Address - Street 1:1100 CLEMENS CENTER PKWY
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-1563
Practice Address - Country:US
Practice Address - Phone:607-733-4783
Practice Address - Fax:607-733-6037
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000010636237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY270039345OtherEIN