Healthcare Provider Details

I. General information

NPI: 1770503898
Provider Name (Legal Business Name): DENNIS STYLES PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 RTE 9W
LAKE KATRINE NY
12449-5410
US

IV. Provider business mailing address

110 S BEDFORD RD CAREMOUNT MEDICAL PC
MOUNT KISCO NY
10549-3446
US

V. Phone/Fax

Practice location:
  • Phone: 845-231-5600
  • Fax: 845-339-1197
Mailing address:
  • Phone: 914-241-1050
  • Fax: 914-242-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009657
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: