Provider Demographics
NPI:1639166192
Name:BUTTON, TIMOTHY L (RPA C)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:L
Last Name:BUTTON
Suffix:
Gender:M
Credentials:RPA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 PRE EMPYION RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456
Mailing Address - Country:US
Mailing Address - Phone:315-230-5646
Mailing Address - Fax:315-230-5645
Practice Address - Street 1:789 PRE-EMPTION RD
Practice Address - Street 2:SUITE 600
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456
Practice Address - Country:US
Practice Address - Phone:315-230-5646
Practice Address - Fax:315-230-5645
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3695363A00000X
NY003695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01269956Medicaid
NY01269956Medicaid
NYPA0990Medicare PIN