Provider Demographics
NPI:1760693659
Name:TIMOTHY W. WILLOX, M.D., PC
Entity Type:Organization
Organization Name:TIMOTHY W. WILLOX, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WILLOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-458-2488
Mailing Address - Street 1:319 S MANNING BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1742
Mailing Address - Country:US
Mailing Address - Phone:518-458-2488
Mailing Address - Fax:518-489-8168
Practice Address - Street 1:319 S MANNING BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1742
Practice Address - Country:US
Practice Address - Phone:518-458-2488
Practice Address - Fax:518-489-8168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185491208600000X
NY231845208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01241170Medicaid
NY02748112Medicaid
NYE90582Medicare UPIN
NY01241170Medicaid
NYI49849Medicare ID - Type Unspecified
NY02748112Medicaid