Healthcare Provider Details

I. General information

NPI: 1679602858
Provider Name (Legal Business Name): DEBORAH B. DYSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH B. DYSON-STOCKNOFF PA

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE 9 EAST 2
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

20 TAYLOR LN
WEST PATERSON NJ
07424-3105
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-8065
  • Fax: 212-263-8251
Mailing address:
  • Phone: 973-345-9270
  • Fax: 973-345-9270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000812
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: