Provider Demographics
NPI:1518206804
Name:HEFELE, TIMOTHY S (LAC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:S
Last Name:HEFELE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 VINCENT LN
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12484-5538
Mailing Address - Country:US
Mailing Address - Phone:845-430-9427
Mailing Address - Fax:
Practice Address - Street 1:12 VINCENT LN
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:NY
Practice Address - Zip Code:12484-5538
Practice Address - Country:US
Practice Address - Phone:845-430-9427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004973171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist