Healthcare Provider Details

I. General information

NPI: 1053246082
Provider Name (Legal Business Name): AIRA DY AGNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 S LITTLE TOR RD
NEW CITY NY
10956-3126
US

IV. Provider business mailing address

142 S LITTLE TOR RD
NEW CITY NY
10956-3126
US

V. Phone/Fax

Practice location:
  • Phone: 845-821-0031
  • Fax:
Mailing address:
  • Phone: 845-821-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG06260163
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: