Healthcare Provider Details

I. General information

NPI: 1548652415
Provider Name (Legal Business Name): TEKIA DYSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 METROPOLITAN OVAL
BRONX NY
10462-6531
US

IV. Provider business mailing address

1 METROPOLITAN OVAL
BRONX NY
10462-6531
US

V. Phone/Fax

Practice location:
  • Phone: 917-686-1283
  • Fax:
Mailing address:
  • Phone: 917-686-1283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number086205
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: