Provider Demographics
NPI:1407800238
Name:MADDEN, TIMOTHY JOHN (PT, DPT, DME)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOHN
Last Name:MADDEN
Suffix:
Gender:M
Credentials:PT, DPT, DME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 NEW HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-1616
Mailing Address - Country:US
Mailing Address - Phone:315-793-1878
Mailing Address - Fax:315-793-1868
Practice Address - Street 1:145 NEW HARTFORD ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413
Practice Address - Country:US
Practice Address - Phone:315-793-1878
Practice Address - Fax:315-793-1868
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5586460001208100000X
2251H1200X
NY009696-2225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5586460001OtherDME SUPPLIER