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Individual

TIMOTHY HALEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
415 TREMONT ST, NORTH TONAWANDA, NY 14120-6135
(716) 690-2028
(716) 690-2398
Mailing address
415 TREMONT ST, NORTH TONAWANDA, NY 14120-6135
(716) 690-2028
(716) 690-2398

Taxonomy

Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
216793
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00025112602
UNIVERA
NY
01
000526057005
BLUE CROSS BLUE SHIELD
NY
05
02104447
NY
01
14-1005
INDEPENDENT HEALTH
NY
Enumeration date
04/20/2006
Last updated
01/18/2011
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