Healthcare Provider Details

I. General information

NPI: 1871613851
Provider Name (Legal Business Name): VICTOR M DYREYES PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMUNITY DR
MANHASSET NY
11030-3816
US

IV. Provider business mailing address

300 COMMUNITY DR DEPARTMENT OF UROLOGY
MANHASSET NY
11030-3816
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-2870
  • Fax:
Mailing address:
  • Phone: 516-562-8250
  • Fax: 516-562-8213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number006208
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: