Timothy Wallace, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

004988-1 Issued in NY

Practice address

450 Clarkson Ave
Box 56
Brooklyn, NY 11203-2056

Phone

(718) 270-1554

Fax

(718) 270-4123

NPI assigned

Feb 15, 2006

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1700850674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 8TH AVE",
            "address_2": "#5F",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112151555",
            "telephone_number": "718-399-2527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 CLARKSON AVE",
            "address_2": "BOX 56",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032056",
            "telephone_number": "718-270-1554",
            "fax_number": "718-270-4123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TIMOTHY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "004988-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pauline Wallace
• Reginald Wallace, M.A.
• Sandra Marie Wallace, RN
• Soraya A Wallace
• Tiffany Wallace
• Valeria Wallace
• Adam Scott Wallach
• Anne Beverly Wallach, MSW
• Jacob Wallach, DPM
• Jeffrey Michael Wallach, L.C.S.W.-R.

• Physician Assistant in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.