Individual
STEPHANIE ELLEN TIMMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
110 HUNNEWELL AVE, ELMONT, NY 11003-2710
(516) 775-7407
Mailing address
110 HUNNEWELL AVE, ELMONT, NY 11003-2710
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
025942
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2020
Last updated
08/30/2022
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