Healthcare Provider Details

I. General information

NPI: 1750427241
Provider Name (Legal Business Name): PEDIATRIC HEAD AND NECK ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E 14TH ST FL 6
NEW YORK NY
10003-4201
US

IV. Provider business mailing address

310 E 14TH ST FL 6
NEW YORK NY
10003-4201
US

V. Phone/Fax

Practice location:
  • Phone: 212-979-4200
  • Fax: 212-979-4510
Mailing address:
  • Phone: 212-979-4200
  • Fax: 212-979-4510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBIN DYLESKI
Title or Position: SOLE OWNER
Credential: M.D.
Phone: 212-979-4200