Provider Demographics
NPI:1730947813
Name:TIMOTHY OKEEFE MD PC
Entity type:Organization
Organization Name:TIMOTHY OKEEFE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:RESTREPO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-603-3795
Mailing Address - Street 1:5501 BARTEL RD
Mailing Address - Street 2:
Mailing Address - City:BREWERTON
Mailing Address - State:NY
Mailing Address - Zip Code:13029-8701
Mailing Address - Country:US
Mailing Address - Phone:315-603-3795
Mailing Address - Fax:
Practice Address - Street 1:5501 BARTEL RD
Practice Address - Street 2:
Practice Address - City:BREWERTON
Practice Address - State:NY
Practice Address - Zip Code:13029-8701
Practice Address - Country:US
Practice Address - Phone:315-603-3795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental