TIMOTHY WALLACE

BROOKLYN, NY
NPI1700850674
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: NY  004988-1)
Enumeration Date2006-02-15
Last Update Date2007-07-08
Business Address
-- TIMOTHY WALLACE PA
450 CLARKSON AVE BOX 56
BROOKLYN, NY 11203-2056
Phone number: 718-270-1554
Mailing Address
-- TIMOTHY WALLACE PA
118 8TH AVE #5F
BROOKLYN, NY 11215-1555
Phone number: 718-399-2527
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