Provider Demographics
NPI:1215901343
Name:TIMMERMANS, ROBERT JOHN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:TIMMERMANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WOODS RD
Mailing Address - Street 2:TCC ROOM D368
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1530
Mailing Address - Country:US
Mailing Address - Phone:914-493-7530
Mailing Address - Fax:914-493-5827
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-909-6900
Practice Address - Fax:914-493-2828
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044074207RC0000X
NY198868207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001449742Medicaid
NY02166530Medicaid
CT060001728Medicare PIN
H35665Medicare UPIN
CT001449742Medicaid