Provider Demographics
NPI:1407310741
Name:BUCKLAEW, TIMOTHY J (PA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:BUCKLAEW
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:57 BAIER DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-5311
Mailing Address - Country:US
Mailing Address - Phone:585-755-3908
Mailing Address - Fax:
Practice Address - Street 1:229 PARRISH ST STE 100
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1791
Practice Address - Country:US
Practice Address - Phone:585-394-1960
Practice Address - Fax:585-393-9232
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2021-05-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant