TIMOTHY WALLACE (NPI# 1700850674) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700850674 |
| Entity Type | Individual |
| Full Name | TIMOTHY WALLACE |
| Credential | PA |
| Practice Address |
450 Clarkson Ave Box 56 Brooklyn NY 11203-2056 |
| Mailing Address |
118 8th Ave #5f Brooklyn NY 11215-1555 |
| Practice Telephone | 7182701554 |
| Practice Fax Number | 7182704123 |
| Mailing Telephone | 7183992527 |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 004988-1 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063438307 | Timothy Mark Wallace | Chiropractor | 4357 Phelan Rd, Phelan, CA 92371-7675 | 2006-07-13 |
| 1437149739 | Timothy R Wallace | Psychologist | 125 Nashua Street, Spaulding Rehab Hospital, Boston, MA 02114-1198 | 2005-10-27 |
| 1619527611 | Timothy Wallace | Case Manager/Care Coordinator | 774 Internet Dr, Columbus, OH 43207-2589 | 2019-09-12 |
| 1396987657 | Timothy Brian Wallace II | Anesthesiology | 550 Peachtree St Ne, Atlanta, GA 30308-2212 | 2009-04-01 |
| 1003072414 | Timothy Thomas Wallace Jr. | Registered Nurse | 10000 Brecksville Rd, Brecksville, OH 44141-3204 | 2008-08-05 |
| 1275725384 | Timothy R Wallace | Family Medicine | 855 N Westhaven Dr, Oshkosh, WI 54904-7668 | 2007-08-13 |
| 1033328703 | Timothy J Wallace | Radiology | 401 College St, Richmond, VA 23298-5017 | 2007-05-21 |
| 1720013121 | Timothy M Wallace | Pathology | 36500 Aurora Dr, Summit, WI 53066-4899 | 2006-07-12 |
| 1841215902 | Timothy Brian Wallace | Anesthesiology | 6605 Abercorn St, Suite 108, Savannah, GA 31405-5815 | 2006-07-12 |
| Street Address |
450 CLARKSON AVE BOX 56 |
| City | BROOKLYN |
| State | NY |
| Zip Code | 11203-2056 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700888013 | David Landman | Internal Medicine | 450 Clarkson Ave, Brooklyn, NY 11203-2056 | 2005-06-01 |
| 1215537345 | Stephanie Galbert | Nurse Practitioner | 450 Clarkson Ave, Brooklyn, NY 11203-2012 | 2020-10-28 |
| 1972118560 | Juveria Ansar Peshimam | Student in an Organized Health Care Education/Training Program | 450 Clarkson Ave, Brooklyn, NY 11203-2012 | 2020-09-10 |
| 1285248831 | Khawar Nawaz | Student in an Organized Health Care Education/Training Program | 450 Clarkson Ave, Brooklyn, NY 11203-2012 | 2020-09-01 |
| 1871107458 | Sneha Naidu Gade | Student in an Organized Health Care Education/Training Program | 450 Clarkson Ave, Brooklyn, NY 11203-2012 | 2020-09-01 |
| 1063025641 | Vaibhaviben Solanki | Student in an Organized Health Care Education/Training Program | 450 Clarkson Ave, Brooklyn, NY 11203-2012 | 2020-08-25 |
| 1548873961 | Bhesh Raj Karki | Student in an Organized Health Care Education/Training Program | 450 Clarkson Ave, Brooklyn, NY 11203-2012 | 2020-08-25 |
| 1174136717 | Cyrilee Maud Thompson | Student in an Organized Health Care Education/Training Program | 450 Clarkson Ave, Brooklyn, NY 11203-2012 | 2020-08-24 |
| 1215548953 | Maximillian Anderson Weigelt | Student in an Organized Health Care Education/Training Program | 450 Clarkson Ave, Brooklyn, NY 11203-2012 | 2020-08-16 |
| 1417568106 | Kereisha Nicole Donegal | Student in an Organized Health Care Education/Training Program | 450 Clarkson Ave, Brooklyn, NY 11203-2012 | 2020-08-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023615747 | Winnie Ming Wong | Dance Therapist | 451 Clarkson Ave R Building, Idd/mh Unit, R5west, Brooklyn, NY 11203 | 2020-10-06 |
| 1174134803 | Jermiah Jonoah Jones | Social Worker | 307 E 54th St, 3, Brooklyn, NY 11203 | 2020-08-14 |
| 1780201566 | Jesvin Jeyapaulraj | Student in an Organized Health Care Education/Training Program | 450 Clarkson Avenue, Suny Downstate, General Surgery Department, Brooklyn, NY 11203 | 2020-06-29 |
| 1881219731 | Natasha Thomas | Specialist | 140 East 52nd St Brooklyn, Apt 1r, Brooklyn, NY 11203 | 2020-06-16 |
| 1679197396 | Syed Hamza Bin Waqar | Student in an Organized Health Care Education/Training Program | 450 Clarkson Avenue, Msc 50, Suny Downstate, Brooklyn, NY 11203 | 2020-05-29 |
| 1013536846 | Isaak Rubinov | Student in an Organized Health Care Education/Training Program | 91 E 39th St, Brooklyn, NY 11203 | 2020-04-12 |
| 1932733615 | Shade Celestine | Specialist | 293 East53rd Street, Brooklyn, NY 11203 | 2020-03-03 |
| 1023656147 | Shenez Brutus | Nurse Practitioner | Suny Downstate College of Nursing, 450 Clarkson Avenue, Brooklyn, NY 11203 | 2019-12-19 |
| 1215586425 | Terry-ann Lee | Registered Nurse | 440 East 45th Street, Kings, NY 11203 | 2019-09-10 |
| 1568023828 | Mmeyeneabasi David Omede | Student in an Organized Health Care Education/Training Program | 450 Clarkson Avenue, Suny Downstate Medical Center, Brooklyn, NY 11203 | 2019-06-26 |
| Find all providers in zip 11203 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952902256 | Billy Phuoctan Truong | Physician Assistant | 8832 18th Ave, Brooklyn, NY 11214-6002 | 2020-11-03 |
| 1700486560 | Jayanti Rao | Physician Assistant | 1059 Union St Apt 3g, Brooklyn, NY 11225-1268 | 2020-10-29 |
| 1376142737 | Amanda Shinall | Physician Assistant | 28 Old Fulton St Apt 4b, Brooklyn, NY 11201-6909 | 2020-10-18 |
| 1497353825 | Tsz Yan Soo | Physician Assistant | 8825 26th Ave Fl 2, Brooklyn, NY 11214-5408 | 2020-10-16 |
| 1164038907 | Emily Mai | Physician Assistant | 1956 W 9th St, Brooklyn, NY 11223-2548 | 2020-09-17 |
| 1497369342 | Krystal Renee Alexander | Physician Assistant | 2225 Ditmas Ave Apt 1a, Brooklyn, NY 11226-6993 | 2020-09-08 |
| 1578177390 | Celia Chen | Physician Assistant | 2628 E 18th St, Brooklyn, NY 11235-3659 | 2020-08-31 |
| 1669084547 | Peter Forman | Physician Assistant | 86 Saint Felix St, Brooklyn, NY 11217-3032 | 2020-08-20 |
| 1699383646 | Fabienne Mondelus | Physician Assistant | 715 E 108th St Apt 3c, Brooklyn, NY 11236-2929 | 2020-07-15 |
| 1508492729 | Esther Weitzner | Physician Assistant | 1195 E 12th St, Brooklyn, NY 11230-4811 | 2020-03-19 |
| Find all providers in BROOKLYN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.