Provider Demographics
NPI:1588284137
Name:TIMOTHEOSE, ASHA
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:TIMOTHEOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 MADISON AVE FL 7
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6368
Mailing Address - Country:US
Mailing Address - Phone:212-867-8862
Mailing Address - Fax:
Practice Address - Street 1:286 MADISON AVE FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6368
Practice Address - Country:US
Practice Address - Phone:212-867-8862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0619761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice