Provider Demographics
NPI:1578755120
Name:LANCASTER, TIMOTHY ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALBERT
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ROUTE 59 STE 103A
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4927
Mailing Address - Country:US
Mailing Address - Phone:845-368-4800
Mailing Address - Fax:845-369-1697
Practice Address - Street 1:255 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4812
Practice Address - Country:US
Practice Address - Phone:845-368-4800
Practice Address - Fax:845-369-1697
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245348207P00000X
NJ25MA08257900207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2453481OtherLICENSE
NJ25MA08257900OtherLICENSE