Healthcare Provider Details

I. General information

NPI: 1518467844
Provider Name (Legal Business Name): DWAYNE PATTERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 AVENUE D
NEW YORK NY
10009-6935
US

IV. Provider business mailing address

15608 RIVERSIDE DR W APT 5J
NEW YORK NY
10032-7008
US

V. Phone/Fax

Practice location:
  • Phone: 646-395-4400
  • Fax:
Mailing address:
  • Phone: 929-810-8783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: