Healthcare Provider Details

I. General information

NPI: 1962731000
Provider Name (Legal Business Name): TREVOR ANTHONY JUSTIN DYSON-HUDSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PLEASANT VALLEY WAY KESSLER FOUNDATION RESEARCH CENTER
WEST ORANGE NJ
07052-1424
US

IV. Provider business mailing address

1199 PLEASANT VALLEY WAY KESSLER FOUNDATION RESEARCH CENTER
WEST ORANGE NJ
07052-1424
US

V. Phone/Fax

Practice location:
  • Phone: 973-324-3576
  • Fax: 973-243-6984
Mailing address:
  • Phone: 973-324-3576
  • Fax: 973-243-6984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number25MA066490000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: