Active NPI
Timothy Fish
- Pharmacist
- Syracuse, NY
National Provider Identifier
1780861161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 039974
- Practice address
- 602 Nottingham Rd
Syracuse, NY 13224-2234 - Phone
- (315) 446-4820
- NPI assigned
- Jan 28, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 039974 | NY | Primary |
Addresses
Primary practice location
602 Nottingham Rd
Syracuse, NY 13224-2234
Mailing address
4660 Providence Rd
Jamesville, NY 13078-8501
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01208048 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 039974 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201478400000",
"number": "1780861161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4660 PROVIDENCE RD",
"city": "JAMESVILLE",
"state": "NY",
"postal_code": "130788501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 NOTTINGHAM RD",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132242234",
"telephone_number": "315-446-4820"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISH",
"first_name": "TIMOTHY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-01-28",
"last_updated": "2008-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "039974",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01208048",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.