Provider Demographics
NPI:1659532232
Name:DEYER, TIMOTHY WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WILLIAM
Last Name:DEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 E 72ND ST STE 103
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4028
Mailing Address - Country:US
Mailing Address - Phone:212-288-1575
Mailing Address - Fax:212-288-7716
Practice Address - Street 1:519 E 72ND ST STE 103
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4028
Practice Address - Country:US
Practice Address - Phone:212-288-1575
Practice Address - Fax:212-288-7716
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2262912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology