Timothy Godfrey, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

25MP00560000 Issued in NJ

Practice address

76 Willowbrook Blvd
Wayne, NJ 07470-7002

Phone

(862) 246-7938

NPI assigned

Apr 13, 2017

Last updated

May 19, 2020By the provider in NPPES

Sex

Male

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

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• New York Hand Surgery of Queens PC

  • Orthopaedic Surgery Physician
  • Woodside, NY
  • NPI 1316520125
  Medicare reassignment
• New York Hand Surgery P.C.

  • Orthopaedic Surgery Physician
  • Brooklyn, NY
  • NPI 1639587504
  Medicare reassignment
• Summit Medical Group, Inc

  dba St. Elizabeth Physicians

  • Family Medicine Physician
  • Erlanger, KY
  • NPI 1750343216
  NPD (past)

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

{
    "created_epoch": "1492041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589846400000",
    "number": "1689108987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "76 WILLOWBROOK BLVD",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074707002",
            "telephone_number": "862-246-7938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 WILLOWBROOK BLVD",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074707002",
            "telephone_number": "862-246-7938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODFREY",
        "first_name": "TIMOTHY",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-13",
        "last_updated": "2020-05-19",
        "certification_date": "2020-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NJ",
            "license": "25MP00560000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eduardo Glass, DPM
• Matthew Franklin Gliksman, MD
• Glow Dental Spa P.C.
• Corey R Glynn, LCSW
• Andrew W. Gnoy, M.D.
• Heidi M Godoy, DPM
• Irma G Godoy, DPM
• Johanna Francesca Godoy, DPM
• Emma Marie Goebel
• Liuan Gof, DC

• Surgical Physician Assistant in Wayne, NJ
• Providers in Wayne, NJ by specialty
• Surgical Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.