Individual
TIMOTHY GERARD BOARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
454 MAPLE AVE, SARATOGA SPRINGS, NY 12866-5532
(518) 587-1141
(518) 587-1152
Mailing address
211 CHURCH ST, SARATOGA SPRINGS, NY 12866-1003
(518) 587-1141
(518) 587-1152
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
004631
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000405957003
BLUE SHIELD
NY
01
—
050510000097
FIDELIS CARE
NY
01
—
709221
MVP
NY
01
—
970016493
RAILROAD MEDICARE
NY
Enumeration date
07/21/2006
Last updated
04/18/2012
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