Healthcare Provider Details

I. General information

NPI: 1487316121
Provider Name (Legal Business Name): ANTHONY DUSHANE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1547 COLUMBIA TPKE
CASTLETON NY
12033-9543
US

IV. Provider business mailing address

1547 COLUMBIA TPKE
CASTLETON NY
12033-9543
US

V. Phone/Fax

Practice location:
  • Phone: 518-479-4156
  • Fax: 518-479-3794
Mailing address:
  • Phone: 518-479-4156
  • Fax: 518-479-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number027414
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number027414
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: