Provider Demographics
NPI:1467453498
Name:JONES, TIMOTHY (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:WHITNEY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:13862
Mailing Address - Country:US
Mailing Address - Phone:607-692-3600
Mailing Address - Fax:607-692-3499
Practice Address - Street 1:7320 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:WHITNEY POINT
Practice Address - State:NY
Practice Address - Zip Code:13862
Practice Address - Country:US
Practice Address - Phone:607-692-3600
Practice Address - Fax:607-692-3499
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG1204333Medicaid
E78917Medicare UPIN
NYBB8731Medicare ID - Type Unspecified