Provider Demographics
NPI:1790995249
Name:DR. TIMOTHY ROBINSON, GENERAL AND FAMILY MEDICINE, P.C.
Entity Type:Organization
Organization Name:DR. TIMOTHY ROBINSON, GENERAL AND FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-631-0072
Mailing Address - Street 1:3245 BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1060
Mailing Address - Country:US
Mailing Address - Phone:718-631-0072
Mailing Address - Fax:718-428-7126
Practice Address - Street 1:3245 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1060
Practice Address - Country:US
Practice Address - Phone:718-631-0072
Practice Address - Fax:718-428-7126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166692-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE39109Medicare UPIN