Healthcare Provider Details

I. General information

NPI: 1639908866
Provider Name (Legal Business Name): DIJON DRUMMOND PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2024
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 E 121ST ST
NEW YORK NY
10035-3523
US

IV. Provider business mailing address

PO BOX 26
VALLEY STREAM NY
11582-0026
US

V. Phone/Fax

Practice location:
  • Phone: 212-801-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406057
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: