Healthcare Provider Details

I. General information

NPI: 1881271997
Provider Name (Legal Business Name): DYLAN GARRETT VANCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 613
HACKENSACK NJ
07601-1962
US

IV. Provider business mailing address

1203 WINDSOR CT
DENVILLE NJ
07834-3444
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-6520
  • Fax: 551-228-7606
Mailing address:
  • Phone: 973-970-4339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA13011400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: