Tyrell Mathew Tillary

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1404 Vista View Dr
Farmingville, NY 11738-3016

Phone

(917) 941-8306

NPI assigned

May 12, 2025

Sex

Unspecified or another gender identity

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1747008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747008000000",
    "number": "1063202182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2114 WILLIAM FLOYD PKWY",
            "city": "RIDGE",
            "state": "NY",
            "postal_code": "119612101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 VISTA VIEW DR",
            "city": "FARMINGVILLE",
            "state": "NY",
            "postal_code": "117383016",
            "telephone_number": "917-941-8306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLARY",
        "first_name": "TYRELL",
        "middle_name": "MATHEW",
        "sole_proprietor": "YES",
        "sex": "X",
        "enumeration_date": "2025-05-12",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lucie Margo Taustine, PH.D.
• Jane M Teitel Negrin, LCSW BCD
• The Farmer'S Medical Group, PC
• The Stop & Shop Supermarket Company LLC
• Jaclyn Tiernan, RN
• Samad Tirmizi
• Genesis Iris Tooker, LPN
• Dennys Torres
• Total Dental Care of Farmingville, LLP
• Dawn Yumi Tottenham, MD

• Student in an Organized Health Care Education/Training Program in Farmingville, NY
• Providers in Farmingville, NY by specialty
• Student in an Organized Health Care Education/Training Program in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.