Provider Demographics
NPI:1952148900
Name:TIMBERLAKE, DINAYJA JOANNE (NYCPS)
Entity type:Individual
Prefix:
First Name:DINAYJA
Middle Name:JOANNE
Last Name:TIMBERLAKE
Suffix:
Gender:F
Credentials:NYCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ELM PL FL 6
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5826
Mailing Address - Country:US
Mailing Address - Phone:718-593-9923
Mailing Address - Fax:718-285-8610
Practice Address - Street 1:25 ELM PL FL 6
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5826
Practice Address - Country:US
Practice Address - Phone:718-593-9923
Practice Address - Fax:718-285-8610
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYCPS-P-6093175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist