Individual
BEVERLY TIMOTHY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9704 SUTPHIN BLVD, JAMAICA, NY 11435-4721
(718) 657-7088
(718) 657-7092
Mailing address
86 COLONIAL AVE, FREEPORT, NY 11520-1251
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
302799
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00695941
—
NY
Enumeration date
02/02/2010
Last updated
07/15/2014
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