Healthcare Provider Details

I. General information

NPI: 1235404559
Provider Name (Legal Business Name): JUDY ROSE DAYAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 E 22ND ST
BROOKLYN NY
11210-3610
US

IV. Provider business mailing address

121 DEKALB AVE
BROOKLYN NY
11201-5493
US

V. Phone/Fax

Practice location:
  • Phone: 917-282-3245
  • Fax:
Mailing address:
  • Phone: 718-250-6277
  • Fax: 718-250-6856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number275072
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: