Provider Demographics
NPI:1447598180
Name:EMANUEL, TIMOTHY STEPHEN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:STEPHEN
Last Name:EMANUEL
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 PURDY ST
Mailing Address - Street 2:APT. 4B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6368
Mailing Address - Country:US
Mailing Address - Phone:917-659-2626
Mailing Address - Fax:
Practice Address - Street 1:1722 PURDY ST
Practice Address - Street 2:APT. 4B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-6368
Practice Address - Country:US
Practice Address - Phone:917-659-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340611-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology