Provider Demographics
NPI:1699509778
Name:GILLIN, TIMOTHY (FNP-BC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:GILLIN
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 LAKEVILLE RD STE M42
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1117
Mailing Address - Country:US
Mailing Address - Phone:516-734-8500
Mailing Address - Fax:516-734-8535
Practice Address - Street 1:450 LAKEVILLE RD STE M42
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1117
Practice Address - Country:US
Practice Address - Phone:516-734-8500
Practice Address - Fax:516-734-8535
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF353477-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily