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NPI Code Detail

MEDICARE: STEVEN DYSON JR.

MEDICARE: STEVEN DYSON JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1740997006
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN DYSON JR.
Provider Business Mailing Address
First Line : 463 7TH AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10018-7448
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 463 7TH AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10018-7448
Country : US
Telephone Number : 646-465-2009
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2022
Last Update Date : 11/04/2022

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